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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 0012FA LORATADINE 10MG TAB (AUR/AHI) LORATADINE LORATADINE 100'S A $8.26 $0.08 TABLET 14 TAB AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 1181FK BISOPROLOL 2.5MG TAB (AUR/AHI) BISOPROLOL BISOPROLOL 100'S A $6.52 $0.07 TABLET 30 TAB AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 5232BF TERBINAFINE 1% LOTION (AUR/AHI) TERBINAFINE TERBINAFINE 30ML C $5.08 $5.08 LOTION 0 BOTT AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 5861JQ TERBINAFINE 250MG TAB (AUR/AHI) TERBINAFINE TERBINAFINE 50'S A $16.39 $0.33 TABLET 28 TAB AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 081404 ALLYAMINES 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
40 7351M CARDIZINE 20MG TAB (AUR/AHI) TRIMETAZIDINE TRIMETAZIDINE CARDIZINE 60'S A $5.33 $0.09 TABLET 90 TAB AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 240404 ANTIARRHYTHMIC AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 A231BE GABAPENTIN 300MG CAP (AUR/AHI) GABAPENTIN GABAPENTIN 100'S A $11.69 $0.12 CAPSULE 180 CAP AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Price Change Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-04-01