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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 1241E RALOXIFENE 60MG TAB (DRL/AHI) RALOXIFENE RALOXIFENE 30'S C 39.88 1.33 TABLET 0 TAB DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 681612 ESTROGEN AGONIST-ANTAGONIST 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 1611U DOCETERE 20MG INJ (DRL/AAL) DOCETAXEL DOCETAXEL DOCETERE 1 DS SYRNG C 39.96 39.96 INJECTION 0 PFS DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 2831GP GLIMEPIRIDE 2MG TAB (DRL/AHI) GLIMEPIRIDE GLIMEPIRIDE 100'S C 12.75 0.13 TABLET 0 TAB DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC B 682020 SULPHONYLUREAS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2832BS GLIMEPIRIDE 4MG TAB (DRL/AHI) GLIMEPIRIDE GLIMEPIRIDE 100'S C 14.62 0.15 TABLET 0 TAB DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC B 682020 SULPHONYLUREAS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 4181BA REDITUX 10MG/ML INJ (DRL/AAL) RITUXIMAB RITUXIMAB REDITUX 50ML C 383.56 383.56 INJECTION 0 VIAL DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 44619 RIVASTIGMINE 1.5MG CAP (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 143.36 2.39 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
40 4462A RIVASTIGMINE 3MG CAP (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 137.38 2.29 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
40 4463J RIVASTIGMINE 4.5MG TAB (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 96.69 1.61 TABLET 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
40 4464K RIVASTIGMINE 6MG CAP (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 107.32 1.79 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 51516 ZIPRASIDONE 20MG CAP (DRL) (BP) ZIPRASIDONE ZIPRASIDONE 60'S BP 42.43 0.7072 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51516 ZIPRASIDONE 20MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 71.36 1.19 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51527 ZIPRASIDONE 40MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.35 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51527 ZIPRASIDONE 40MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.3537 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51527 ZIPRASIDONE 40MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.35 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51535 ZIPRASIDONE 60MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.72 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51535 ZIPRASIDONE 60MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.7239 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51535 ZIPRASIDONE 60MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.72 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51546 ZIPRASIDONE 80MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.21 2.09 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51546 ZIPRASIDONE 80MG CAP (DRL) (BP) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.21 2.0868 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51546 ZIPRASIDONE 80MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.15 2.09 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 ORAL 0 ATYPICAL ANTIPSYCHOTICS