Displaying 1 - 19 of 19
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 0113G ALCOVERA 1G INJ (UNI) CEFAZOLIN (BQ) CEFAZOLIN ALCOVERA 1G VIAL BQ 4.46 4.4581 VIAL 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 08120612 THIRD GEN CEPHALOSPORINS 2024-04-01 2026-03-31 IV 0 THIRD GEN CEPHALOSPORINS
41 0482AF METRONIDAZOLE 0.5% INJ (UNI) (B) METRONIDAZOLE METRONIDAZOLE 100ML B 1.88 1.8756 BOTT 0 BOTT UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 IV 0 ANTIPROTOZOALS, MISCELLANEOUS
40 14269 IFIMOL 10MG/ML INJ (UNI/AHI) PARACETAMOL PARACETAMOL IFIMOL 100ML B 3.94 3.94 INJECTION 0 BOTT UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
41 14269 IFIMOL 10MG/ML INJ (UNI) PARACETAMOL (B) PARACETAMOL IFIMOL 100ML B 4.89 4.893 BOTT 0 BOTT UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2024-04-01 2026-03-31 IV 0 ANALGESICS AND PYRETICS MISCELLANEOUS
40 4144DG DICLORAN SR 75MG TAB (UNI/AHI) DICLOFENAC SOD DICLOFENAC SODIUM DICLORAN SR 10X10 A 6.74 0.07 TABLET 28 TAB UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 6712BX CIPLOXIN 200MG INJ (UNI/AHI) CIPROFLOXACIN CIPROFLOXACIN CIPLOXIN 100ML BQ 4.49 4.49 INJECTION 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 081218 QUINOLONES 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS
41 6712BX CIPLOXIN 200MG INJ (UNI) CIPROFLOXA (BQ) CIPROFLOXACIN CIPLOXIN 100ML BQ 4.49 4.4852 VIAL 56 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 081218 QUINOLONES 2024-04-01 2026-03-31 IV 0 QUINOLONES
40 6732Z CONTRAPAQUE 300MG/ML INJ (UNI/AHI) IOHEXOL IOHEXOL CONTRAPAQUE 50ML BQ 42.70 42.70 INJECTION 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
40 6734AQ CONTRAPAQUE 350MG/ML INJ (UNI/AHI) IOHEXOL IOHEXOL CONTRAPAQUE 50ML BQ 43.06 43.06 INJECTION 0 VIAL UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
40 6735E XULVARIO 350MG/ML INJ (UNI/AHI) IOHEXOL IOHEXOL XULVARIO 100ML BQ 55.62 55.62 INJECTION 0 BOTT UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 IV 0 DIAGNOSTIC AGENTS
40 74712 DEPIXOL DEPOT 20MG/ML INJ (LUN/COL) FLUPENTHI FLUPENTHIXOL DEPIXOL DEPOT 10X1ML B 117.95 11.80 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 74715 CLOPIXOL ACUPHASE 50MG/ML(LUN/COL)ZUCLOPENTHI ZUCLOPENTHIXOL CLOPIXOL ACUPHASE 5X1ML C 105.53 21.11 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 74719 CLOPIXOL DEPOT 200MG/ML(LUN/COL)ZUCLOPENTHI ZUCLOPENTHIXOL CLOPIXOL DEPOT 10X1ML C 374.72 37.47 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473C CLOPIXOL 10MG TAB (LUN/COL) ZUCLOPENTHIXOL ZUCLOPENTHIXOL CLOPIXOL 100'S C 485.22 4.85 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473J CLOPIXOL 2MG TAB (LUN/COL) ZUCLOPENTHIXOL ZUCLOPENTHIXOL CLOPIXOL 100'S C 485.22 4.85 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473K DEPIXOL 3MG TAB (LUN/COL) FLUPENTHIXOL FLUPENTHIXOL DEPIXOL 100'S A 115.09 1.15 TABLET 180 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322FQ LEXAPRO 10MG TAB (LUN/COL) ESCITALOPRAM ESCITALOPRAM LEXAPRO 28'S C 90.76 3.24 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322JU CIPRAMIL 20MG TAB (LUN/COL) CITALOPRAM CITALOPRAM CIPRAMIL 14'S C 48.09 3.44 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KD LEXAPRO 20MG TAB (LUN/COL) ESCITALOPRAM ESCITALOPRAM LEXAPRO 14'S C 89.54 6.40 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS