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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
42 04863 EPAQ 0.75% VAG CR (GRM) METRONIDAZOLE METRONIDAZOLE EPAQ 40G A 26.64 26.64 TUBE 1 TUBE GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 VAGINAL 0 ANTIPROTOZOALS, MISCELLANEOUS
40 3061B HYPERRHOD 300MCG INJ (GRB/COL) ANTI D IMMUNOG ANTI-D IMMUNOGLOBULIN HYPERRHOD 300MCG VL BQ 250.09 250.09 INJECTION 0 VIAL GRB GRIFOLS BIOLOGICALS INC COL COLLINS LTD 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
40 49412 PLASBUMIN 25% INJ (GRB/COL) ALBUMIN ALBUMIN PLASBUMIN 12.5G VIAL BQ 101.94 101.94 INJECTION 0 VIAL GRB GRIFOLS BIOLOGICALS INC COL COLLINS LTD 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
42 5841JS TRITACE 5MG TAB (GRM) RAMIPRIL RAMIPRIL TRITACE 2X10 C 37.84 1.89 TAB 45 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC B 243204 ACE INHIBITORS 2026-04-01 ORAL 6 ACE INHIBITORS
42 5842JQ TRITACE 10MG TAB (GRM) RAMIPRIL RAMIPRIL TRITACE 15'S C 46.16 3.08 TAB 30 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC B 243204 ACE INHIBITORS 2026-04-01 ORAL 6 ACE INHIBITORS
42 5843FK TRITACE 2.5MG TAB (GRM) RAMIPRIL RAMIPRIL TRITACE 2X10 C 25.25 1.26 TAB 45 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC B 243204 ACE INHIBITORS 2026-04-01 ORAL 6 ACE INHIBITORS
42 6091L TRENTAL 400MG TAB (GRM) PENTOXIFYLLINE PENTOXIFYLLINE TRENTAL 2X10 C 26.91 1.35 TAB 90 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC 2024 HEMORRHEOLOGICS 2026-04-01 ORAL 6 HEMORRHEOLOGICS
42 7911AF NORGESIC 35MG|500MG TAB (GRM) ORPHENADRINE|PARACETAMOL ORPHENADRINE|PARACETAMOL NORGESIC 5X10 C 33.98 0.68 TAB 0 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2026-04-01 ORAL 0 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS