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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 0531V IMURAN 50MG TAB (ASG/STO) AZATHIOPRINE AZATHIOPRINE IMURAN 100'S C $174.27 $1.74 TABLET 0 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
40 0621C PURINETHOL 50MG TAB (ASG/STO) MERCAPTOPURINE MERCAPTOPURINE PURINETHOL 25'S A $104.38 $4.18 TABLET 60 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
40 1171V ALDOMET 250MG TAB (ASG/STO) METHYLDOPA METHYLDOPA ALDOMET 30'S A $5.44 $0.18 TABLET 180 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 240816 CENTRAL ALPHA ANTAGONIST 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1172K ALDOMET 500MG TAB (ASG/STO) METHYLDOPA METHYLDOPA ALDOMET 30'S A $8.83 $0.29 TABLET 180 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 240816 CENTRAL ALPHA ANTAGONIST 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 3571ZV ZYLOPRIM 100MG TAB (ASG/STO) ALLOPURINOL ALLOPURINOL ZYLOPRIM 50'S C $27.18 $0.54 TABLET 0 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 4040 URICOSURIC AGENTS 2022-04-01 2024-03-31 Oral 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 6302AQ NIMBEX 2MG/ML INJ (ASG/STO) CISATRACURIUM CISATRACURIUM NIMBEX 5X5ML BQ $114.17 $22.83 INJECTION 0 VIAL ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 122020 NEUROMUSCULAR BLOCKING AGENTS 2022-04-01 2024-03-31 IV 0 AUTONOMIC DRUGS