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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 0531A AZATHIOPRINE 50MG TAB (RPG/AHI) AZATHIOPRINE AZATHIOPRINE 100'S A 28.27 0.28 TABLET 180 TAB RPG RPG LIFE SCIENCES LTD AHI ARMSTRONG HEALTHCARE INC B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
42 0531A AZATHIOPRINE 50MG TAB (RPG) AZATHIOPRINE AZATHIOPRINE 100'S A 22.45 0.22 TAB 180 BLIS RPG RPG LIFE SCIENCES LTD AHI ARMSTRONG HEALTHCARE INC B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 ORAL 6 IMMUNOSUPPRESSIVE AGENTS