Displaying 1 - 12 of 12
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 2593DR FAMOTIDINE 20MG TAB (APL/AHI) FAMOTIDINE FAMOTIDINE 100'S C 24.85 0.25 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
40 28439 METFORMIN 1G TAB (APL/AHI) METFORMIN METFORMIN 100'S A 10.76 0.11 TABLET 90 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC B 682004 BIGUANIDES 2022-04-01 2024-03-31 Amend Protocol Quantity Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES 2022-08-15
41 65712 CLOZAPINE 25MG TAB (APL/AHI) CLOZAPINE CLOZAPINE 100'S BP 122.9498 1.2295 TAB 270 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS ORAL 6 CENTRAL NERVOUS SYSTEM DRUGS
40 65712 CLOZAPINE 25MG TAB (APL/AHI) CLOZAPINE CLOZAPINE 100'S BP 97.32 0.97 TABLET 270 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2022-07-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A321AH VENLAFAXINE ER 37.5MG TAB (APL/AHI) VENLAFAXI VENLAFAXINE VENLAFAXINE ER 30'S BP 10.90 0.36 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322HL FLUOXETINE 20MG CAP (APL/AHI) FLUOXETINE FLUOXETINE 100'S A 11.20 0.11 CAPSULE 120 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322JV VENLAFAXINE SR 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE SR 1000'S BP 516.21 0.52 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-09-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A322KN FLUOXETINE 20MG TAB (APL/AHI) FLUOXETINE FLUOXETINE 1000'S A 120.97 0.12 TABLET 120 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-09-20 2024-03-31 Package Size Change oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-09-20
40 A322KR VENLAFAXINE ER 150MG CAP (APL/AHI) VENLAFAXIN VENLAFAXINE VENLAFAXINE ER 90'S BP 69.43 0.77 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KS VENLAFAXINE ER 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE ER 30'S BP 18.97 0.63 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A573P ALENDRONATE 70MG TAB (APL/AHI) ALENDRONATE ALENDRONATE 4'S B 3.62 0.91 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 9224 BONE RESORPTION INHIBITORS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 B051B DOLUTEGRAVIR 50MG TAB (APL/ATB) DOLUTEGRAVIR DOLUTEGRAVIR 30'S BL 10.66 0.36 TABLET 0 TAB APL AUROBINDO PHARMA LTD. ATB ANSA TRADING BARBADOS LTD 08180812 INTEGRASE INHIBITORS 2022-04-12 2024-03-31 Add to Contract as Cat B oral 0 ANTI-INFECTIVE AGENTS 2022-04-12