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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
41 1351F RESTRIVA 500MG TAB (TRO) METAMIZOL METAMIZOL RESTRIVA 150'S A 21.77 0.1451 TAB 30 BOX TRO TROIKAA AHI ARMSTRONG HEALTHCARE INC 2808 ANALGESICS-ANTIPYRETICS 2024-04-01 2026-03-31 ORAL 0 ANALGESICS-ANTIPYRETICS 2024-03-11