Displaying 1 - 12 of 12
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 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
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 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 4144DA DICLO-SR 75MG TAB (RYV/ALW) DICLOFENAC SOD DICLOFENAC SODIUM DICLO-SR 100'S A 6.90 0.07 TABLET 28 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 4144DA DICLO-SR 75MG SR TAB (RYV) DICLOFENAC SODIUM DICLOFENAC SODIUM DICLO-SR 100'S A 8.1 0.081 TABSR 28 BOX RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 ORAL 6 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
40 5811FD AMLODIPINE 10MG TAB (RYV/ALW) AMLODIPINE AMLODIPINE 100'S A 2.80 0.03 TABLET 30 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC B 242808 DIHYDROPYRIDINES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 5814AG AMLODIPINE 5MG TAB (RYV/ALW) AMLODIPINE AMLODIPINE 10X10 A 2.42 0.02 TABLET 45 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC B 242808 DIHYDROPYRIDINES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 6673AE DICLO-K 50MG TAB (RYV/ALW) DICLOFENAC POTASSI DICLOFENAC POTASSIUM DICLO-K 100'S A 2.69 0.03 TABLET 15 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 6673AE DICLO-K 50MG TAB (RYV) DICLOFENAC POTASS DICLOFENAC POTASSIUM DICLO-K 100'S A 4.05 0.0405 TAB 15 BOX RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 ORAL 0 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS