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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 2551C FLEET ENEMA ADULT 7G | 19G (FLE/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA ADULT 133ML A 2.23 2.23 2 ENMA FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 6 GASTROINTESTINAL DRUGS 2021-12-17
41 2551C FLEET ENEMA ADULT 7G|19G ENEMA (FLE) SODIUM BIPHOSPHATE|SODI SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA ADULT 133ML A 2.94 2.9358 ENMA 2 BOX FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2024-04-01 2026-03-31 RECTAL 6 CATHARTICS AND LAXATIVES
40 25527 FLEET ENEMA PAED 3.5G | 9.5G (FLE/AHI) SODIUM SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA PAED 66ML B 5.79 5.79 0 ENMA FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 0 GASTROINTESTINAL DRUGS 2021-12-17
41 25527 FLEET ENEMA PAED 3.5G|9.5G (FLE) SODIUM SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA PAED 66ML A 3.26 3.262 ENMA 2 BOX FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2024-04-01 2026-03-31 RECTAL 6 CATHARTICS AND LAXATIVES
40 4091R GLYCERINE ADULT 2G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE ADULT 12'S A 2.47 0.21 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 6 GASTROINTESTINAL DRUGS
40 4092H GLYCERINE PAED 1G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE PAED 12'S A 2.88 0.24 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 0 GASTROINTESTINAL DRUGS