Displaying 1 - 20 of 53
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 00521 XELODA 500MG TAB (ROC/AHI) CAPECITABINE CAPECITABINE XELODA 120'S C 326.20 2.72 TABLET 0 TAB ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
41 0451Z BACTRIM FORTE 800MG|160MG TAB (ROC) SULFAMETHOXAZOLE|TRIMETH (B) SULFAMETHOXAZOLE|TRIMETHOPRIM BACTRIM FORTE 10'S B 11.42 1.1417 TAB 28 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 081220 SULPHONAMIDES 2024-04-01 2026-03-31 ORAL 0 SULPHONAMIDES
41 04536 BACTRIM 80MG|16MG/ML INJ (ROC) SULFAMETHOXAZOLE|TRIMETHOPRIM (C) SULFAMETHOXAZOLE|TRIMETHOPRIM BACTRIM 10X5ML C 10.6 1.0602 AMP 0 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 081220 SULPHONAMIDES 2024-04-01 2026-03-31 IV 0 SULPHONAMIDES
41 1232B ISOSORBIDE DINITRATE 5MG TAB (ROL) ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 100'S A 116.72 1.1672 TAB 120 BOX ROL ROXANE LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
41 1351F RESTRIVA 500MG TAB (TRO) METAMIZOL METAMIZOL RESTRIVA 150'S A 21.77 0.1451 TAB 30 BOX TRO TROIKAA AHI ARMSTRONG HEALTHCARE INC 2808 ANALGESICS-ANTIPYRETICS 2024-04-01 2026-03-31 ORAL 0 ANALGESICS-ANTIPYRETICS 2024-03-11
40 1763L PROMETHAZINE 25MG/ML INJ (ROL/AHI) PROMETHAZINE PROMETHAZINE 25X1ML B 204.04 8.16 INJECTION 0 AMP ROL ROXANE LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2022-09-30 IV 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 36223 PROLOPA 50MG | 200MG TAB (ROC/AHI) BENSERAZIDE | BENSERAZIDE|LEVODOPA PROLOPA 30'S A 40.77 1.36 TABLET 240 TAB ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 283616 DOPAMINE PRECURSORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 36223 PROLOPA 50MG|200MG TAB (ROC) BENSERAZIDE|LEVODOPA BENSERAZIDE|LEVODOPA PROLOPA 30'S A 30.15 1.005 TAB 240 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 283616 DOPAMINE PRECURSORS 2024-09-27 2026-03-31 ORAL 6 DOPAMINE PRECURSORS 2024-09-27
40 41811 MABTHERA 10MG/ML INJ (ROC/AHI) RITUXIMAB RITUXIMAB MABTHERA 100MG VIAL C 1,391.78 1,391.78 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 41811 MABTHERA 10MG/ML INJ (ROC) RITUXIMAB (BQ) RITUXIMAB MABTHERA 100MG VIAL BQ 1391.78 1391.7819 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 4181A AVASTIN 25MG/ML INJ (ROC/AHI) BEVACIZUMAB BEVACIZUMAB AVASTIN 100MG VIAL C 1,003.06 1,003.06 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181A AVASTIN 25MG/ML INJ (ROC) BEVACIZUMAB (C) BEVACIZUMAB AVASTIN 100MG VIAL C 1003.06 1003.0616 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 4181B AVASTIN 25MG/ML INJ (ROC/AHI) BEVACIZUMAB BEVACIZUMAB AVASTIN 400MG VIAL C 4,012.25 4,012.25 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181B AVASTIN 25MG/ML INJ (ROC) BEVACIZUMAB (C) BEVACIZUMAB AVASTIN 400MG VIAL C 4012.25 4012.2462 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 4181BB MABTHERA 10MG/ML INJ (ROC/AHI) RITUXIMAB RITUXIMAB MABTHERA 50ML C 3,479.45 3,479.45 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181BB MABTHERA 10MG/ML INJ (ROC) RITUXIMA (BQ) RITUXIMAB MABTHERA 50ML BQ 3479.45 3479.4547 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 4181BC MABTHERA SC 1400MG INJ (ROC/AHI) RITUXIMAB RITUXIMAB MABTHERA SC 11.7ML C 4,392.81 4,392.81 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181BC MABTHERA SC 1400MG INJ (ROC) RITUXIMAB (BQ) RITUXIMAB MABTHERA SC 11.7ML BQ 4392.81 4392.8116 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
41 4181BL PHESGO 60MG/ML|60MG/ML INJ (ROC) PERTUZUMAB|TRASTUZUMAB (C) PERTUZUMAB|TRASTUZUMAB PHESGO 10ML C 12626.62 12626.62 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 SC 0 IMMUNOSUPPRESSIVE AGENTS
41 4181BW PHESGO 1200MG|600MG INJ (ROC) PERTUZUMAB|TRASTUZUMAB (C) PERTUZUMAB|TRASTUZUMAB PHESGO 15ML VIAL C 21270.89 21270.885 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 SC 0 ANTINEOPLASTICS