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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
41 57829 TRUVERA 0.5MG|0.4MG CAP (TMP) DUTASTERIDE|TAMSULOSIN MR (C) DUTASTERIDE|TAMSULOSIN MR TRUVERA 3X10 C 23.89 0.7965 CAP 0 BOX TMP THE MADRAS PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 9208 5 ALPHA REDUCTASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 5 ALPHA REDUCTASE INHIBITORS
41 6031R REJUN 50MG TAB (TMP) CLOMIPHENE CLOMIPHENE REJUN 10'S C 4.29 0.4295 TAB 0 BOX TMP THE MADRAS PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 681612 ESTROGEN AGONIST-ANTAGONIST 2024-04-01 2026-03-31 ORAL 0 ESTROGEN AGONIST-ANTAGONIST
40 B001D CABERGOLINE 0.5MG TAB (TMP/AHI) CABERGOLINE CABERGOLINE 4'S BQ 30.83 7.71 TABLET 0 TAB TMP THE MADRAS PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 283620 DOPAMINE RECEPTOR AGONIST 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS