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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 1941B MULTISTIX 10SG STRP (BYC/AHI) DIAGNOSTIC URINE DIAGNOSTIC URINE MULTISTIX 10SG 100'S C 62.52 62.52 STRIP 0 BOTT BYC BAYER S.A AHI ARMSTRONG HEALTHCARE INC 3688 URINE CONTENTS 2022-04-01 2024-03-31 0 DIAGNOSTIC AGENTS
40 3701AP BAYER NEXT EZ GLUC (BYC/AHI) DIAGNOSTIC BLOO DIAGNOSTIC BLOOD GLUCOSE BAYER NEXT EZ 50'S A 40.23 40.23 GLUCOSE STRI 1 PACK BYC BAYER S.A AHI ARMSTRONG HEALTHCARE INC B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS