Displaying 1 - 19 of 19
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 1542A DIAMIN 25MG TAB (RLS/AHI) IMIPRAMINE IMIPRAMINE DIAMIN 200'S A 18.87 0.09 TABLET 240 TAB RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 28160428 TRICYCLICS & OTHER NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 3081Y IMMUNOREL 5% INJ (RLS/AHI) IMMUNOGLOBULIN IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 657.29 657.29 INJECTION 0 BOTT RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL (BQ) IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 807.34 807.3422 BOTT 0 BOTT RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
42 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL IMMUNOGLOBULIN HUMAN IMMUNOREL 100ML BQ 807.34 807.34 BOTT 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
41 3082A IMMUNOREL 10% INJ (RLS) IMMUNOGLOBU (BQ) IMMUNOGLOBULIN IMMUNOREL 100ML BQ 1353.73 1353.7254 VIAL 50 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2024-04-01 2026-03-31 IV 0 SERUMS
40 31717 ADALIREL 40MG INJ (RLS/AHI) ADALIMUMAB ADALIMUMAB ADALIREL 0.8ML SYRN C 875.30 875.30 INJECTION 0 PFS RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 4181BK INFLIXIRIL 100MG INJ (RLS/AHI) INFLIXIMAB INFLIXIMAB INFLIXIRIL 100ML C 1,058.52 1,058.52 INJECTION 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181BR BEVACIREL 25MG/ML INJ (RLS) BEVACIZUMAB (C) BEVACIZUMAB BEVACIREL 4ML VIAL C 430.58 430.5825 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
41 4181N RITUXIMAB 10MG/ML INJ (RLS) (BQ) RITUXIMAB RITUXIMAB 10ML BQ 190.01 190.0108 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 4582P HEMOREL A 500IU INJ (RLS/AHI) FACTOR VIII FACTOR VIII HEMOREL A 500IU VIAL BQ 330.28 330.28 INJECTION 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 4582P HEMOREL A 500IU INJ (RLS) FACTOR VI (BQ) FACTOR VIII HEMOREL A 500IU VIAL BQ 305.81 305.8115 VIAL 12 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2024-04-01 2026-03-31 IV 0 HEMOSTATICS
42 4582P HEMOREL A 500IU INJ (RLS) FACTOR VI FACTOR VIII HEMOREL A 500IU VIAL BQ 309.48 309.48 VIAL 12 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2026-04-01 IV 0 HEMOSTATICS
42 49418 ALBUREL 25% INJ (RLS) ALBUMIN ALBUMIN ALBUREL 50ML BQ 127.87 127.87 VIAL 40 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 8004 SERUMS 2026-04-01 IV 0 SERUMS
40 7691C INTERFERON ALPHA 2B 3MU INJ (RLS/AHI) INTERFERON ALPHA 2B INTERFERON ALPHA 2B 3MU VIAL C 49.72 49.72 INJECTION 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 081820 INTERFERONS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
41 7691C INTERFERON ALPHA 2B 3MU INJ (RLS) INTERFERON ALPHA 2B INTERFERON ALPHA 2B 3MU VIAL C 23.65 23.6494 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 081820 INTERFERONS 2024-04-01 2026-03-31 IV 0 INTERFERONS
42 7691D RELIFERON 300MU/0.5ML INJ (RLS) INTERFERON ALPHA 2B INTERFERON ALPHA 2B RELIFERON 3MU VIAL BQ 24.14 24.14 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 081820 INTERFERONS 2026-04-01 SC 0 INTERFERONS
40 B4913 OMALIREL 150MG INJ (RLS/AHI) OMALIZUMAB OMALIZUMAB OMALIREL 150MG VIAL C 844.86 844.86 INJECTION 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2022-04-01 2024-03-31 IV 0 RESPIRATORY TRACT AGENTS
41 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB (C) OMALIZUMAB OMALIREL 150MG VIAL C 844.86 844.8551 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2024-04-01 2026-03-31 IV 0 RESPIRATORY INFLAMMATORY AGENTS
42 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB OMALIZUMAB OMALIREL 150MG VIAL BQ 747.54 747.54 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2026-04-01 IV 0 RESPIRATORY INFLAMMATORY AGENTS