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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 4361AA BURETROL SOLUTION SET (BAX) ADMIN SET A (B) ADMIN SET ADULT BURETROL SOLUTION SET B 3.53 3.5338 SET 10 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 4361AA BURETROL SOLUTION SET (BAX) ADMIN SET A ADMIN SET ADULT BURETROL SOLUTION SET B 7.23 7.23 SET 10 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43648 IRRIG SET Y-TYPE (2C4005) (BAX/STO) ADMIN S ADMIN SET GLYCINE IRRIG SET Y-TYPE (2C4005) SET B 15.17 15.17 SET 0 SET BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43648 IRRIG SET Y-TYPE (2C4005) (BAX) (B) ADMIN SET GLYCINE IRRIG SET Y-TYPE (2C4005) SET B 18.51 18.5118 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43648 IRRIG SET Y-TYPE (2C4005) (BAX) ADMIN SET GLYCINE IRRIG SET Y-TYPE (2C4005) SET B 11.31 11.31 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43649 ECOSPIKE (BRA/COL) ADMIN SET GLYCINE ADMIN SET GLYCINE ECOSPIKE SET B 8.45 8.45 SET 0 SET BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43649 ECOSPIKE (BRA) ADMIN SET GLYCINE (B) ADMIN SET GLYCINE ECOSPIKE SET B 9.38 9.3782 SET 10 BAG BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43649 ECOSPIKE (BRA) ADMIN SET GLYCINE (C) ADMIN SET GLYCINE ECOSPIKE SET C 13.54 13.54 SET 10 BAG BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43664 BURETROL INTERLINK ( 2C7564) SET (BAX/STO) ADMIN SET PAED BURETROL INTERLINK ( 2C7564) SET B 16.74 16.74 SET 0 SET BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43664 BURETROL INTERLINK ( 2C7564) SET (BAX) (B) ADMIN SET PAED BURETROL INTERLINK ( 2C7564) SET B 23.76 23.7582 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43664 BURETROL INTERLINK ( 2C7564) SET (BAX) ADMIN SET PAED BURETROL INTERLINK ( 2C7564) SET B 30.72 30.72 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 4366R BURETROL ADD ON CLEARLINK SET (BAX/STO) ADMI ADMIN SET PAED BURETROL ADD ON CLEARLINK SET B 12.37 12.37 SET 0 SET BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 4366R BURETROL ADD ON CLEARLINK SET (BAX) ADM (B) ADMIN SET PAED BURETROL ADD ON CLEARLINK SET B 17.91 17.9138 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 4366R BURETROL ADD ON CLEARLINK SET (BAX) ADM ADMIN SET PAED BURETROL ADD ON CLEARLINK SET B 18.65 18.65 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 4366S BURETROL SOL PAED (2C8862) SET (BAX/STO) ADM ADMIN SET PAED BURETROL SOL PAED (2C8862) SET B 15.85 15.85 SET 0 SET BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 4366S BURETROL SOL PAED (2C8862) SET (BAX) AD (B) ADMIN SET PAED BURETROL SOL PAED (2C8862) SET B 20.96 20.9583 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
40 43683 VENTED PACLITAXEL (2C7557) SET (BAX/STO) ADM ADMIN SET VENTED PACLITAXEL (2C7557) SET B 11.55 11.55 SET 0 SET BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43683 VENTED PACLITAXEL (2C7557) SET (BAX) AD (B) ADMIN SET VENTED PACLITAXEL (2C7557) SET B 18.51 18.5118 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43683 VENTED PACLITAXEL (2C7557) SET (BAX) AD ADMIN SET VENTED PACLITAXEL (2C7557) SET BQ 24.19 24.19 SET 10 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43684 INTRAFIX PRIME LINE COMFORT PV SET (BRA/COL) ADMIN SET ADMIN SET INTRAFIX PRIME LINE COMFORT PV SET B 1.88 1.88 SET 0 SET BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES