Displaying 1 - 20 of 29
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
41 1691B THIORIDAZINE 10MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 221.9 2.219 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 ORAL 6 PHENOTHIAZINES
42 1691B THIORIDAZINE 10MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 221.90 2.22 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
41 1692M THIORIDAZINE 25MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 312.06 3.1206 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2024-04-01 2026-03-31 ORAL 6 PHENOTHIAZINES
42 1692M THIORIDAZINE 25MG TAB (MAT) THIORIDAZINE THIORIDAZINE 100'S A 312.06 3.12 TAB 360 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
42 1693C THIORIDAZINE 50MG TAB (MAT) THIORIDAZINE THIORIDAZINE 1000'S A 364.42 0.36 TAB 300 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
42 17016 TRIFLUOPERAZINE 1MG TAB (MAT) TRIFLUOPERAZINE TRIFLUOPERAZINE 1000'S A 153.01 0.15 TAB 252 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28160824 PHENOTHIAZINES 2026-04-01 ORAL 6 PHENOTHIAZINES
40 22827 ACETAZOLAMIDE 500MG INJ (MAT/AHI) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 182.67 182.67 INJECTION 0 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 22827 ACETAZOLAMIDE 500MG INJ (MAT) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 182.89 182.8888 VIAL 10 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 IV 6 CARBONIC ANHYDRASE INHIBITORS
42 22827 ACETAZOLAMIDE 500MG INJ (MAT) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 189.39 189.39 VIAL 10 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 IV 0 CARBONIC ANHYDRASE INHIBITORS
42 2592AM FAMOTIDINE 10MG/ML INJ (MAT) FAMOTIDINE FAMOTIDINE 25X2 ML BQ 129.80 5.19 AMPG 0 AMP MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2026-04-01 IV 0 HISTAMINE RECEPTOR ANTAGONIST
42 2593DU SUCRALFATE 1G TAB (MAT) SUCRALFATE SUCRALFATE 100'S A 83.81 0.84 TAB 120 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 562832 GI PROTECTANTS 2026-04-01 ORAL 6 GI PROTECTANTS
40 A681AM EFAVIRENZ | EMTRICITABINE | TENOFOVIR 600MG | 200MG | 300MG TAB (MAT/AHI) EFAVIRENZ|EMTRICITABINE|TENOFOVIR EFAVIRENZ|EMTRICITABINE|TENOFOVIR 30'S BL 27.59 0.92 TABLET 0 TAB MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180892 ANTIRETROVIRALS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 A681AM EFAVIRENZ|EMTRICITABINE|TENOFOVIR 600MG|200MG|300MG TAB (MAT (BL) EFAVIRENZ|EMTRICITABINE|TENOFOVIR EFAVIRENZ|EMTRICITABINE|TENOFOVIR 30'S BL 30.17 1.0058 TAB 60 BOX MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 081892 ANTIVIRALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIVIRALS, MISCELLANEOUS
42 A681AM EFAVIRENZ|EMTRICITABINE|TENOFOVIR 600MG|200MG|300MG TAB (MAT EFAVIRENZ|EMTRICITABINE|TENOFOVIR EFAVIRENZ|EMTRICITABINE|TENOFOVIR 30'S BL 27.59 0.92 TAB 60 BLIS MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 081892 ANTIVIRALS, MISCELLANEOUS 2026-04-01 ORAL 0 ANTIVIRALS, MISCELLANEOUS
40 A681HB ZOVILAM 150MG | 300MG TAB (MAT/AHI) LAMIVUDINE | ZIDOVUDINE LAMIVUDINE|ZIDOVUDINE ZOVILAM 60'S BL 21.20 0.35 TABLET 0 TAB MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180892 ANTIRETROVIRALS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 A681HB ZOVILAM 150MG|300MG TAB (MAT) LAMIVUDINE|ZIDOVUDINE (BL) LAMIVUDINE|ZIDOVUDINE ZOVILAM 60'S BL 30.17 0.5029 TAB 60 BOX MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180820 NRTI 2024-04-01 2026-03-31 ORAL 6 NRTI
42 A681HD ATAZANAVIR|RITONAVIR 300MG|100MG TA ATAZANAVIR|RITONAVIR ATAZANAVIR|RITONAVIR 30'S BL 61.16 2.04 TAB 60 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180820 NRTI 2026-04-01 ORAL 0 NRTI
40 A681HE ABACAVIR | LAMIVUDINE 600MG | 300MG TAB (MAT/AHI) ABACAVIR|LAMIVUDINE ABACAVIR|LAMIVUDINE 30'S BL 63.61 2.12 TABLET 0 TAB MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180892 ANTIRETROVIRALS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 A681HK LOPINAVIR | RITONAVIR 200MG | 50MG TAB (MAT/AHI) LOPINAVIR|RITONAVIR LOPINAVIR|RITONAVIR 120'S BL 85.63 0.71 TABLET 0 TAB MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180892 ANTIRETROVIRALS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 A681HL EMTRICITABINE | TENOFOVIR 200MG | 300MG TAB (MAT/AHI) EMTRICITABINE|TENOFOVIR EMTRICITABINE|TENOFOVIR 30'S BL 29.19 0.97 TABLET 0 TAB MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08180892 ANTIRETROVIRALS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS