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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 1131FK ATORVASTATIN 10MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 1.44 0.05 TABLET 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1132GU ATORVASTATIN 20MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 4.65 0.16 TABLET 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2022-10-19 Delete from contract Oral 6 CARDIOVASCULAR DRUGS 2022-09-07
40 1132GU ATORVASTATIN 20MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 1.74 0.058 TABLET IMMED 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2023-03-20 2024-03-31 Add to Contract as Cat A Oral 6 HMG-CoA REDUCTASE INHIBITORS 2023-01-12
40 1133FP ATORVASTATIN 40MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 2.53 0.08 TABLET 60 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 7726BS PIPERACILLIN | TAZOBACTAM 4G | 0.5G INJ (UME/AHI) PIPERACILLIN|TAZOBACTAM PIPERACILLIN|TAZOBACTAM 4.5G VIAL BQ 4.46 4.46 INJECTION 0 VIAL UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS 2022-04-01 2022-09-30 IV 0 ANTI-INFECTIVE AGENTS 2022-03-29