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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 0012ES RHINIL SR 10MG TAB (ARP) CETIRIZINE CETIRIZINE RHINIL SR 100'S A 7.42 0.0742 TAB 14 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
41 0012FR AXOFEN 120MG TAB (ARP) FEXOFENADINE (C) FEXOFENADINE AXOFEN 30'S C 23.27 0.7756 TAB 0 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 0292J CLINEX 150MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 3X10 A 9.65 0.32 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0292J CLINEX 150MG CAP (ARP) CLINDAMYCIN HCL (C) CLINDAMYCIN HCL CLINEX 3X10 C 10.28 0.3425 CAP 28 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2024-04-01 2026-03-31 ORAL 0 LINCOMYCINS
40 0294K CLINEX 300MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 30'S A 18.76 0.63 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0294K CLINEX 300MG CAP (ARP) CLINDAMYCIN HCL (C) CLINDAMYCIN HCL CLINEX 30'S C 18.76 0.6252 CAP 28 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2024-04-01 2026-03-31 ORAL 0 LINCOMYCINS
40 0531A AZATHIOPRINE 50MG TAB (RPG/AHI) AZATHIOPRINE AZATHIOPRINE 100'S A 28.27 0.28 TABLET 180 TAB RPG RPG LIFE SCIENCES LTD AHI ARMSTRONG HEALTHCARE INC B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
40 07219 FLACORT 6MG TAB (ARP/AHI) DEFLAZACORT DEFLAZACORT FLACORT 3X10 C 8.97 0.30 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 12148 NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN GLYCERYL TRINITRATE NITROCARD 200 DOSES A 17.61 17.61 SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 23414 MATROPIN 2% EYE DR (ARP/AHI) HOMATROPINE HOMATROPINE MATROPIN 10ML A 14.11 14.11 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2371H OXOZOLIN 0.05% NASAL DR (ARP/AHI) OXYMETAZOLI OXYMETAZOLINE OXOZOLIN 10ML A 4.57 4.57 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2371H OXOZOLIN 0.05% NASAL DR (ARP) OXYME OXYMETAZOLINE OXOZOLIN 10ML A 4.95 4.9473 BOTT 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 NASAL 0 EENT VASOCONSTRICTORS
40 2373G OXOZOLIN PAED 0.025% NASAL DR (ARP/AHI) OXYME OXYMETAZOLINE OXOZOLIN PAED 10ML A 4.05 4.05 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2662E SONEXA 0.1% EYE DR (ARP/AHI) DEXAMETHASONE DEXAMETHASONE SONEXA 5ML B 4.57 4.57 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2713N CORTISOL 20MG TAB (ARP) PREDNISOLONE PREDNISOLONE CORTISOL 100'S A 8.21 0.0821 TAB 90 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-04-01 2024-09-30 ORAL 6 ADRENALS 2024-08-19
41 2713R PREDNISOLONE 20MG TAB (ARP) PREDNISOLONE PREDNISOLONE 50'S A 4.1 0.082 TAB 90 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2024-10-01 2026-03-31 ORAL 6 ADRENALS 2024-08-20
40 3653CS FLUTICASONE 27.5MCG NASAL SP (ARP/AHI) FLUTICASONE FLUTICASONE 120 DOSES A 12.99 12.99 NASAL SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 NASAL 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4253AR DERMOCIN 2% OINT (ARP/AHI) MUPIROCIN MUPIROCIN DERMOCIN 10G BQ 5.16 5.16 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 4253AR DERMOCIN 2% OINT (ARP) MUPIROCIN (BQ) MUPIROCIN DERMOCIN 10G BQ 5.16 5.1648 TUBE 2 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTIBIOTICS TOPICAL
40 4701AX SYSTEAR 0.4% | 0.3% EYE DR (ARP/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL SYSTEAR 10ML A 7.34 7.34 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS