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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 0013AZ LEVOCETIRIZINE 2.5MG/ML SYR (CIR/AHI) LEVOCETIRIZINE LEVOCETIRIZINE 60ML C 5.71 0.10 SYRUP 0 ML CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0124R CHLORAMPHENICOL 0.5% EYE DR (CIR/AHI) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.90 1.90 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 0124R CHLORAMPHENICOL 0.5% EYE DR (CIR) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 2.07 2.0659 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
42 0452AT CO-TRIMOXAZOLE 40MG/ML|8MG/ML SUSP (CIR) SULFAMETHOXAZOLE|TR SULFAMETHOXAZOLE|TRIMETHOPRIM CO-TRIMOXAZOLE 100ML A 4.89 0.05 ML 200 BOTT CIR CIRON PHARMA CWS CAPSULE WHOLESALE 081220 SULPHONAMIDES 2026-04-01 ORAL 0 SULPHONAMIDES
40 0742X BENZTROPINE 1MG/ML INJ (CIR/AHI) BENZTROPINE BENZTROPINE 2ML B 5.11 5.11 INJECTION 0 AMP CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 283608 ANTICHOLINERGIC AGENTS (PARKINSONS) 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
41 09415 PANCURONIUM BROMIDE 2MG/ML INJ (CIR (B) PANCURONIUM BROMIDE PANCURONIUM BROMIDE 10X2ML B 52.3 5.2301 AMP 0 BOX CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 122020 NEUROMUSCULAR BLOCKING AGENTS 2024-04-01 2026-03-31 IV 0 NEUROMUSCULAR BLOCKING AGENTS
41 1133FS ATORVASTATIN 40MG TAB (CIR) ATORVASTATIN ATORVASTATIN 30'S A 2.01 0.0671 TAB 60 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 HMG-CoA REDUCTASE INHIBITORS
40 1181EV CILENOL 2.5MG TAB (CIR/AHI) BISOPROLOL BISOPROLOL CILENOL 30'S A 2.75 0.09 TABLET 30 TAB CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2022-09-30 Oral 6 CARDIOVASCULAR DRUGS 2022-03-29
40 1182EQ CILENOL 5MG TAB (CIR/AHI) BISOPROLOL BISOPROLOL CILENOL 30'S A 4.24 0.14 TABLET 30 TAB CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1184M CILENOL 10MG TAB (CIR/AHI) BISOPROLOL BISOPROLOL CILENOL 3X10 A 5.06 0.17 TABLET 30 TAB CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE DORZOLAMIDE|TIMOLOL DORZOL-T 10ML A 21.61 21.61 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 12116 ANGIRON 0.5MG SL TAB (CIR/AHI) GLYCERYL TRINI GLYCERYL TRINITRATE ANGIRON 30'S A 11.53 11.53 TABLET 30 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 23717 XYLOMETAZOLINE 0.1% NASAL DR (CIR/AHI) XYLOMETAZOLINE XYLOMETAZOLINE 10ML A 2.66 2.66 NASAL DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2022-09-30 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29
40 2373S XYLOMETAZOLINE 0.05% NASAL DR (CIR/AHI) XYLOMETAZOLINE XYLOMETAZOLINE 10ML A 2.31 2.31 NASAL DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2022-09-30 NASAL 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29
40 2562C DIMENHYDRINATE 3MG/ML SYR (CIR/AHI) DIMENHYDRINATE DIMENHYDRINATE 150ML A 4.54 0.03 SYRUP 125 ML CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5622 ANTIEMETICS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
40 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR/AHI) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 1.98 1.98 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR) (B) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 2.31 2.3106 VIAL 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2026-03-31 IV 0 ADRENALS
40 26935 HYDROCORTISONE SOD SUCC 500MG INJ (CIR/AHI) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 50X500MG B 268.95 5.38 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2721N TRIAMCINOLONE 40MG/ML INJ (CIR/AHI) TRIAMCINOLONE TRIAMCINOLONE 1ML VIAL B 2.99 2.99 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2721N TRIAMCINOLONE 40MG/ML INJ (CIR) (B) TRIAMCINOLONE TRIAMCINOLONE 1ML VIAL B 3.29 3.2892 VIAL 4 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2026-03-31 IV 6 ADRENALS