Displaying 1 - 14 of 14
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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 1431BD TADOL RETARD 100MG TAB (KRK/AHI) TRAMADOL TRAMADOL TADOL RETARD 30'S A 16.31 0.54 TABLET 28 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 280808 OPIATE AGONISTS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1431BL TADOL RETARD 100MG TAB (KRK/AHI) TRAMADOL TRAMADOL TADOL RETARD 30'S A 16.31 0.54 TABLET 28 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 280808 OPIATE AGONISTS 2022-04-01 2022-09-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
41 1431BL TADOL RETARD 100MG ER TAB (KRK) TRAMADOL TRAMADOL TADOL RETARD 30'S A 16.31 0.5437 TABER 28 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 280808 OPIATE AGONISTS 2024-04-01 2026-03-31 ORAL 6 OPIATE AGONISTS
42 1431BL TADOL RETARD 100MG ER TAB (KRK) TRAMADOL TRAMADOL TADOL RETARD 30'S A 16.31 0.54 TAB 28 BLIS KRK KRKA AHI ARMSTRONG HEALTHCARE INC 280808 OPIATE AGONISTS 2026-04-01 ORAL 6 OPIATE AGONISTS
41 2491AR DEXAMET. SOD. PHOS. 4MG/ML IV/IM INJ (KR (B) DEXAMETHASONE SODIUM PHOSPHATE DEXAMET. SOD. PHOS. 25X1ML B 16.31 0.6524 AMP 0 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2026-03-31 IV/IM 0 ADRENALS
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 30.09 1.07 TABLET 0 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2022-06-16 Oral 0 AUTONOMIC DRUGS
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q 28'S A 30.09 1.07 TABLET 30 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-06-17 2022-09-30 Oral 6 AUTONOMIC DRUGS 2022-06-17
41 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL (C) DONEPEZIL YASNAL Q 28'S C 30.09 1.0747 TAB 30 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 30.09 1.07 TAB 30 BLIS KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S C 47.57 1.70 TABLET 0 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 Oral 0 AUTONOMIC DRUGS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S A 47.57 1.70 TABLET 30 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-06-17 2022-09-30 Oral 6 AUTONOMIC DRUGS 2022-06-17
41 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL (C) DONEPEZIL YASNAL Q 28'S C 47.57 1.699 TABDISP 0 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 47.57 1.70 TABDISP 0 BLIS KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 ORAL 0 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 6711JQ NOLICIN 400MG TAB (KRK) NORFLOXACIN NORFLOXACIN NOLICIN 20'S A 8.16 0.41 TAB 14 BOTT KRK KRKA AHI ARMSTRONG HEALTHCARE INC 081218 QUINOLONES 2026-04-01 ORAL 0 QUINOLONES