Displaying 1 - 17 of 17
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 30612 RHOPHYLAC 300MCG INJ (CSL/AHI) ANTI-D IMMUNOG ANTI-D IMMUNOGLOBULIN RHOPHYLAC 2ML AMP BQ 108.73 108.73 INJECTION 0 AMP CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 30612 RHOPHYLAC 300MCG INJ (CSL) ANTI-D IMMUNO ANTI-D IMMUNOGLOBULIN RHOPHYLAC 2ML AMP BQ 122.32 122.3246 AMP 2 AMP CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
42 3061E RHOPHYLAC 150MCG/ML PREFIL SYRN (CSL) IMMUNOGLOBULIN ANTI-D IMMUNOGLOBULIN ANTI-D RHOPHYLAC 1X2ML PFS BQ 122.32 122.32 PFS 0 PFS CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IV/IM 0 SERUMS 2025-11-10
40 30827 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN PRIVIGEN 50ML BQ 951.41 951.41 INJECTION 0 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 30827 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) IMMUNOGLOBULIN HUMAN PRIVIGEN 50ML BQ 883.46 883.4553 BOTT 50 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
40 30828 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN PRIVIGEN 100ML BQ 1,413.53 1,413.53 INJECTION 0 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2022-05-10 IV 0 SERUMS, TOXOIDS AND VACCINES 2022-03-29
41 30828 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) IMMUNOGLOBULIN HUMAN PRIVIGEN 100ML BQ 1766.91 1766.9106 BOTT 50 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
42 3082D PRIVIGEN 10% INJ (CSL) HUMAN IMMUNOGLOBULIN HUMAN IMMUNOGLOBULIN PRIVIGEN 100ML BQ 1,603.81 1,603.81 VIAL 0 BOTT CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IV/IM/SC 0 SERUMS 2025-11-10
40 30914 TETAGAM 250IU INJ (CSL/AHI) TETANUS ANTITOXIN TETANUS ANTITOXIN TETAGAM 1ML AMP B 67.96 67.96 INJECTION 0 AMP CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 30914 TETAGAM 250IU INJ (CSL) TETANUS ANTITOXI TETANUS ANTITOXIN TETAGAM 1ML AMP B 108.73 108.733 AMP 40 AMP CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8012 VACCINES 2024-04-01 2026-03-31 IV 0 VACCINES
42 3091J TETAGAM P 250IU/ML PREFIL SYRN (CSL) IMMUNOGLOBULIN HUMAN TETANUS IMMUNOGLOBULIN HUMAN TETAGAM P 4X1ML PFS B 108.73 108.73 PFS 0 PFS CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IM 0 SERUMS 2025-11-10
40 4582A BERIATE 500IU INJ (CSL/AHI) FACTOR VIII FACTOR VIII BERIATE 10ML VIAL BQ 244.65 244.65 INJECTION 0 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 4582A BERIATE 500IU INJ (CSL) FACTOR VIII (BQ) FACTOR VIII BERIATE 10ML VIAL BQ 244.65 244.6492 VIAL 12 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2024-04-01 2026-03-31 IV 0 HEMOSTATICS
42 4582T BERIATE 500IU INJ (CSL) FACTOR VIII FACTOR VIII BERIATE 500IU VIAL BQ 244.65 244.65 VIAL 12 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2026-04-01 Add to Contract IV 0 HEMOSTATICS 2025-11-10
41 49416 ALBUREX 20% INJ (CSL) ALBUMIN (BQ) ALBUMIN ALBUREX 50ML VIAL BQ 73.12 73.1229 VIAL 40 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IM 0 SERUMS
42 4941AG ALBURX 25% INJ (CSL) HUMAN ALBUMIN HUMAN ALBUMIN ALBURX 50ML VIAL BQ 91.06 91.06 VIAL 0 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 Add to Contract IV 0 SERUMS 2025-11-10
41 4941U ALBUREX 25% INJ (CSL) ALBUMIN (BQ) ALBUMIN ALBUREX 50ML VIAL BQ 91.06 91.0639 VIAL 40 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS