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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 0051F CAPECITABINE 150MG TAB (INP/AHI) CAPECITABINE CAPECITABINE 6X10 BQ 194.20 3.24 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
42 0051M CAPECITABINE 150MG TAB (INP) CAPECITABINE CAPECITABINE 10'S BQ 15.79 1.58 TAB 230 PACK INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2026-04-01 ORAL 0 ANTINEOPLASTICS
40 0582B CYTARABINE 1G INJ (INP/AHI) CYTARABINE CYTARABINE 1G VIAL BQ 38.46 38.46 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 0631AD METHOTREXATE 2.5MG TAB (INP/AHI) METHOTREXATE METHOTREXATE 100'S A 12.72 0.13 TABLET 32 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
40 0633V METHACOR 25MG/ML INJ (INP/AHI) METHOTREXATE METHOTREXATE METHACOR 2ML VIAL B 8.70 8.70 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 0634M METHOTREXATE 25MG/ML INJ (INP/AHI) METHOTREXATE METHOTREXATE 20ML VIAL BQ 46.43 46.43 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 06351 METHOTREXATE 25MG/ML INJ (INP/AHI) METHOTREXATE METHOTREXATE 40ML BQ 82.12 82.12 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 06417 ACCORD MITOMYCIN 5MG INJ (INP/AAL) MITOMYCIN MITOMYCIN ACCORD MITOMYCIN 5MG VIAL BQ 203.06 203.06 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 11045 ACCORD PROPRANOLOL 80MG TAB (INP/AAL) PROPRANOLOL ACCORD PROPRANOLOL 56'S A 13.40 0.24 TABLET 150 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1131FW LIPITAS 10MG TAB (INP/AHI) ATORVASTATIN ATORVASTATIN LIPITAS 30'S A 3.56 0.1187 TABLET IMMED INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2023-03-20 2024-03-31 Add to Contract as Cat A Oral 6 HMG-CoA REDUCTASE INHIBITORS 2023-01-04
41 1131GT ATORVASTATIN 10MG TAB (INP) ATORVASTATIN ATORVASTATIN 1000'S A 35.96 0.036 TAB 30 BOTT INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 HMG-CoA REDUCTASE INHIBITORS
40 1132HE LIPITAS 20MG TAB (INP/AHI) ATORVASTATIN ATORVASTATIN LIPITAS 30'S A 4.32 0.144 TABLET IMMED 30 INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2023-03-20 2024-03-31 Add to Contract as Cat A Oral 6 HMG-CoA REDUCTASE INHIBITORS 2023-01-04
40 1133FV LIPITAS 40MG TAB (INP/AHI) ATORVASTATIN ATORVASTATIN LIPITAS 30'S A 5.41 0.1803 TABLET IMMED 30 INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2023-03-20 2024-03-31 Add to Contract as Cat A Oral 6 HMG-CoA REDUCTASE INHIBITORS 2023-01-04
40 1601AL ACCORD DIAZEPAM 2MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 2.34 0.08 TABLET 120 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1603AK ACCORD DIAZEPAM 10MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 3.67 0.12 TABLET 60 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1612S DOCETAXEL 80MG INJ (INP/AHI) DOCETAXEL DOCETAXEL 80MG VIAL C 65.70 65.70 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 1932AK INTAGRA 50MG TAB (INP/AHI) SILDENAFIL SILDENAFIL INTAGRA 4'S BQ 1.20 0.30 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 241212 PHOSPHODIESTERASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 1932AK INTAGRA 50MG TAB (INP) SILDENAFIL (BQ) SILDENAFIL INTAGRA 4'S BQ 0.95 0.2378 TAB 30 BOX INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 241212 PHOSPHODIESTERASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 PHOSPHODIESTERASE INHIBITORS
40 19536 IBANDRONIC ACID 1MG/ML INJ (INP/AAL) IBANDRONIC ACID IBANDRONIC ACID 6ML VIAL C 9.51 9.51 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 9224 BONE RESORPTION INHIBITORS 2022-04-01 2024-03-31 IV 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 2841DL ZOMET 500MG TAB (INP) METFORMIN METFORMIN ZOMET 10X10 A 4.08 0.0408 TAB 180 BOX INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC B 682004 BIGUANIDES 2024-04-01 2026-03-31 ORAL 6 BIGUANIDES