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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 | 0791X | ADRENALINE 1MG/ML IV/IM INJ (LAF/AHI) | ADRENALINE | ADRENALINE | 100X1ML | B | 99.38 | 0.99 | INJECTION | 0 | AMP | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 121212 | ALPHA & BETA ADRENERGIC AGONIST | 2022-04-01 | 2024-03-31 | Change Local Agent | IV/IM | 0 | AUTONOMIC DRUGS | 2022-02-03 | |||
| 41 | 0791X | ADRENALINE 1MG/ML IV/IM INJ (LAF) (B) | ADRENALINE | ADRENALINE | 100X1ML | B | 114.17 | 1.1417 | AMP | 60 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 121212 | ALPHA & BETA ADRENERGIC AGONIST | 2024-04-01 | 2026-03-31 | IV/IM | 0 | ALPHA & BETA ADRENERGIC AGONIST | |||||
| 42 | 0791X | ADRENALINE 1MG/ML IV/IM INJ (LAF) | ADRENALINE | ADRENALINE | 100X1ML | B | 95.14 | 0.95 | AMPG | 60 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 121212 | ALPHA & BETA ADRENERGIC AGONIST | 2026-04-01 | IV/IM | 0 | ALPHA & BETA ADRENERGIC AGONIST | ||||||
| 41 | 1432AY | TRAMADOL 50MG/ML INJ (LAF) (B) | TRAMADOL | TRAMADOL | 100X1ML | B | 161.2 | 1.612 | VIAL | 30 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 280808 | OPIATE AGONISTS | 2024-04-01 | 2026-03-31 | IV/IM | 6 | OPIATE AGONISTS | |||||
| 40 | 2551F | ENEMA-LAX ADULT 7G | 19G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX ADULT | 133ML | A | 3.89 | 3.89 | ENEMA | 2 | ENMA | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 6 | GASTROINTESTINAL DRUGS | 2022-02-03 | |||
| 42 | 2551F | ENEMA-LAX ADULT 7G|19G ENEMA (LAF) SODIUM BIPHOSPHATE|SODIUM | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX ADULT | 133ML | B | 8.83 | 8.83 | BOTT | 2 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2026-04-01 | ORAL | 6 | CATHARTICS AND LAXATIVES | ||||||
| 40 | 25528 | ENEMA-LAX CHILD 9.5G | 3.5G ENEMA (LAF/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHAT More ... | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX CHILD | 66ML | A | 3.89 | 3.89 | ENEMA | 2 | ENMA | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 6 | GASTROINTESTINAL DRUGS | 2022-02-03 | |||
| 42 | 25528 | ENEMA-LAX CHILD 9.5G|3.5G ENEMA (LAF) SODIUM BIPHOSPHATE|SOD | SODIUM BIPHOSPHATE|SODIUM PHOSPHATE | ENEMA-LAX CHILD | 66ML | A | 8.16 | 8.15 | BOTT | 2 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5612 | CATHARTICS AND LAXATIVES | 2026-04-01 | ORAL | 6 | CATHARTICS AND LAXATIVES | ||||||
| 40 | 2565Y | DIMENHYDRINATE 50MG/ML INJ (LAF/AHI) | DIMENHYDRINATE | DIMENHYDRINATE | 100X1ML | B | 142.41 | INJECTION | 0 | INJ | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5622 | ANTIEMETICS | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 0 | GASTROINTESTINAL DRUGS | 2022-02-03 | ||||
| 42 | 2565Y | DIMENHYDRINATE 50MG/ML IV/IM INJ (LAF) | DIMENHYDRINATE | DIMENHYDRINATE | 100X1ML | B | 114.17 | 1.14 | AMPG | 60 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 5622 | ANTIEMETICS | 2026-04-01 | ORAL | 6 | ANTIEMETICS | ||||||
| 40 | 26517 | BETAMETHASONE 0.5MG TAB (LAF/AHI) | BETAMETHASONE | BETAMETHASONE | 100'S | A | 56.38 | 0.56 | TABLET | 240 | TAB | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6804 | ADRENALS | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 6 | HORMONES AND SYNTHETIC SUBSTITUTES | 2022-02-03 | |||
| 41 | 26517 | BETAMETHASONE 0.5MG TAB (LAF) | BETAMETHASONE | BETAMETHASONE | 100'S | A | 61.16 | 0.6116 | TAB | 240 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6804 | ADRENALS | 2024-04-01 | 2026-03-31 | ORAL | 6 | ADRENALS | |||||
| 42 | 26517 | BETAMETHASONE 0.5MG TAB (LAF) | BETAMETHASONE | BETAMETHASONE | 100'S | A | 47.03 | 0.47 | TAB | 240 | BLIS | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6804 | ADRENALS | 2026-04-01 | ORAL | 6 | ADRENALS | ||||||
| 40 | 2962S | SEGUIDET 1.5MG TAB (LAF/AHI) LEVONORGESTREL | LEVONORGESTREL | SEGUIDET | 1'S | C | 5.22 | 5.22 | TABLET | 0 | TAB | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6812 | CONTRACEPTIVES | 2022-04-01 | 2024-03-31 | Change Local Agent | Oral | 0 | HORMONES AND SYNTHETIC SUBSTITUTES | 2022-02-03 | |||
| 41 | 2962S | SEGUIDET 1.5MG TAB (LAF) LEVONORGESTREL (C) | LEVONORGESTREL | SEGUIDET | 1'S | C | 5.44 | 5.4366 | TAB | 1 | BOX | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6812 | CONTRACEPTIVES | 2024-04-01 | 2026-03-31 | ORAL | 0 | CONTRACEPTIVES | |||||
| 42 | 2962S | SEGUIDET 1.5MG TAB (LAF) LEVONORGESTREL | LEVONORGESTREL | SEGUIDET | 1'S | C | 5.44 | 5.44 | TAB | 1 | BLIS | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 6812 | CONTRACEPTIVES | 2026-04-01 | ORAL | 0 | CONTRACEPTIVES | ||||||
| 42 | 3051AB | OXYTOCIN 10U/ML INJ (LAF) | OXYTOCIN | OXYTOCIN | 100X1ML | BQ | 86.04 | 0.86 | VIAL | 0 | VIAL | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 7600 | OXYTOCICS | 2026-04-01 | IV | 0 | OXYTOCICS | ||||||
| 41 | 5062AK | DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) | REHYDRATION SALTS | DEX-LITOS | 25'S | C | 31.26 | 1.2504 | BOX | 0 | SACH | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 4012 | REPLACEMENT THERAPY | 2024-04-01 | 2026-03-31 | ORAL | 0 | REPLACEMENT THERAPY | |||||
| 42 | 5062AK | DEX-LITOS PWDR (LAF) REHYDRATION SALTS | REHYDRATION SALTS | DEX-LITOS | 25'S | C | 31.26 | 1.25 | BOX | 10 | SACH | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 4012 | REPLACEMENT THERAPY | 2026-04-01 | ORAL | 0 | REPLACEMENT THERAPY | ||||||
| 41 | 5062AL | DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) | REHYDRATION SALTS | DEX-LITOS | 50'S | C | 63.88 | 1.2776 | BOX | 0 | SACH | LAF | LABORATORIOS ALFA | AHI | ARMSTRONG HEALTHCARE INC | 4012 | REPLACEMENT THERAPY | 2024-04-01 | 2026-03-31 | ORAL | 0 | REPLACEMENT THERAPY | |||||