Displaying 1 - 20 of 62
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 0012ER GLENCET 5MG TAB (GLP/ALI) LEVOCETIRIZINE LEVOCETIRIZINE GLENCET 30'S C 6.80 0.23 TABLET 0 TAB GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2022-03-22 Delete from contract Oral 0 ANTIHISTAMINICS 2022-03-22
40 0072D ZOLPIDEM 10MG TAB (RYV/ALW) ZOLPIDEM ZOLPIDEM 30'S C 18.62 0.62 TABLET 0 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 0072D ZOLPIDEM 10MG TAB (RYV) (C) ZOLPIDEM ZOLPIDEM 30'S C 18.62 0.6207 TAB 0 BOX RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCEL
40 0093A FLUVIN 25MG/ML SUSP (RYV/ALW) GRISEOFULVIN GRISEOFULVIN FLUVIN 100ML A 12.21 0.12 SUSPENSION 500 ML RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
41 0211AT MEROPENEM 500MG INJ (MON) (BQ) MEROPENEM MEROPENEM 10X500MG BQ 9.49 0.9487 VIAL 42 BOX MON MONTAGE PHARMACEUTICALS ALI ALL HEALTH INC 08120708 CARBAPENEMS 2024-04-01 2026-03-31 IV 2 CARBAPENEMS
40 06417 ACCORD MITOMYCIN 5MG INJ (INP/AAL) MITOMYCIN MITOMYCIN ACCORD MITOMYCIN 5MG VIAL BQ 203.06 203.06 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 11045 ACCORD PROPRANOLOL 80MG TAB (INP/AAL) PROPRANOLOL ACCORD PROPRANOLOL 56'S A 13.40 0.24 TABLET 150 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1133EV ATORVASTATIN 40MG TAB (RYV/ALW) ATORVASTATIN ATORVASTATIN 30'S A 2.12 0.07 TABLET 60 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1601AL ACCORD DIAZEPAM 2MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 2.34 0.08 TABLET 120 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1603AK ACCORD DIAZEPAM 10MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 3.67 0.12 TABLET 60 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1611U DOCETERE 20MG INJ (DRL/AAL) DOCETAXEL DOCETAXEL DOCETERE 1 DS SYRNG C 39.96 39.96 INJECTION 0 PFS DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 19536 IBANDRONIC ACID 1MG/ML INJ (INP/AAL) IBANDRONIC ACID IBANDRONIC ACID 6ML VIAL C 9.51 9.51 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 9224 BONE RESORPTION INHIBITORS 2022-04-01 2024-03-31 IV 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 2962Q PINKPILL 1.5MG TAB (RYV/ALW) LEVONORGESTREL LEVONORGESTREL PINKPILL 1'S C 4.05 4.05 TABLET 0 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2962Q PINKPILL 1.5MG TAB (RYV) LEVONORGES (C) LEVONORGESTREL PINKPILL 1'S C 4.05 4.0503 TAB 1 BOX RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 6832 PROGESTINS 2024-04-01 2026-03-31 ORAL 0 PROGESTINS
40 3592D LAMEZ 50MG TAB (INP/AAL) LAMOTRIGINE LAMOTRIGINE LAMEZ 56'S B 58.28 1.04 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 3631AX ACCORD METOCLOPRAMIDE 10MG TAB (INP/AAL) METO METOCLOPRAMIDE ACCORD METOCLOPRAMIDE 30'S A 1.96 0.07 TABLET 90 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
40 3701AW TRUE METRIX (HOM/ALI) DIAGNOSTIC BLOOD GLUC DIAGNOSTIC BLOOD GLUCOSE TRUE METRIX 50'S A 30.04 30.04 GLUCOSE STRI 1 PACK HOM NIPRO DIAGNOSTICS ALI ALL HEALTH INC B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 3701BE SELECT FLEX PLUS GLUC (JOH/AAL) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.23 39.2254 PACK 1 BOX JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
40 3701V LIFESCAN ONE TOUCH ULTRA GLUC (JOH/AAL) DIAG DIAGNOSTIC BLOOD GLUCOSE LIFESCAN ONE TOUCH ULTRA 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS