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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
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS