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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 1132JT ATORVASTATIN 20MG TAB (MOR) ATORVASTATIN ATORVASTATIN 30'S A 1.58 0.05 TAB 30 BLIS MOR MORACEAE CWS CAPSULE WHOLESALE 240608 HMG-CoA REDUCTASE INHIBITORS 2026-04-01 ORAL 6 HMG-CoA REDUCTASE INHIBITORS
42 1134BD ATORVASTATIN 80MG TAB (MOR) ATORVASTATIN ATORVASTATIN 30'S A 3.04 0.10 TAB 30 BLIS MOR MORACEAE CWS CAPSULE WHOLESALE 240608 HMG-CoA REDUCTASE INHIBITORS 2026-04-01 ORAL 6 HMG-CoA REDUCTASE INHIBITORS
41 15929 CHLORPROMAZINE 50MG TAB (TOR) CHLORPROMAZINE CHLORPROMAZINE 500'S A 264.2755 0.5286 TAB 90 BOTT TOR TORRENT PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 ORAL 6 PHENOTHIAZINES
40 5692K ACYCLOVIR 5% OINT (TOR/AHI) ACYCLOVIR ACYCLOVIR 15G C 69.32 69.32 OINT 0 TUBE TOR TORRENT PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 TOPICAL 0 ANTI-INFECTIVE AGENTS
41 5692K ACYCLOVIR 5% OINT (TOR) ACYCLOVIR ACYCLOVIR 15G C 69.32 69.3173 TUBE 2 BOX TOR TORRENT PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 A671CE MONTELUKAST CHEWABLE 10MG TAB (TOR/AHI) MONTE MONTELUKAST MONTELUKAST CHEWABLE 90'S A 14.81 0.16 TABLET 30 TAB TOR TORRENT PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 481024 LEUKOTRIENE MODIFIERS 2022-04-01 2024-03-31 Oral 6 RESPIRATORY TRACT AGENTS