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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 43684 INTRAFIX PRIME LINE COMFORT PV SET (BRA) ADMIN SET (B) ADMIN SET INTRAFIX PRIME LINE COMFORT PV SET B 2.15 2.1475 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
40 43719 VIAL PLASTIC, AMBER 15ML/4 DR (DCN/COL) BOT BOTTLES VIAL PLASTIC, AMBER 15ML|4 DR 200'S B 28.43 0.14 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43719 VIAL PLASTIC, AMBER 15ML/4 DR (DCN) BOTTLES VIAL PLASTIC, AMBER 15ML|4 DR 200'S B 30.04 0.1502 EACH 4 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43719 VIAL PLASTIC, AMBER 15ML/4 DR (DCN) BOTTLES VIAL PLASTIC, AMBER 15ML|4 DR 200'S B 34.14 0.17 EACH 4 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43728 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN/COL) BOTTLES VIAL, PLASTIC, AMBER 25ML|7 DR 200'S B 31.61 0.16 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43729 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN) (B) Vials VIAL, PLASTIC, AMBER 25ML/7 DR 500'S B 83.1 0.1662 EACH 0 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 ORAL 0 MEDICAL DEVICES
42 43729 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN) VIALS VIALS VIAL, PLASTIC, AMBER 25ML/7 DR 500'S B 94.43 0.19 EACH 0 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 ORAL 0 MEDICAL DEVICES
40 43738 VIAL, PLASTIC, AMBER 40ML/10DR (DCN/COL) BO BOTTLES VIAL, PLASTIC, AMBER 40ML|10DR 200'S B 43.66 0.22 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43738 VIAL, PLASTIC, AMBER 40ML/10DR (DCN) BOTTLES VIAL, PLASTIC, AMBER 40ML|10DR 200'S B 46.21 0.2311 EACH 4 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43738 VIAL, PLASTIC, AMBER 40ML/10DR (DCN) BOTTLES VIAL, PLASTIC, AMBER 40ML|10DR 200'S B 52.49 0.26 EACH 4 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43749 VIAL, PLASTIC, AMBER 60ML/16DR (DCN/COL) BO BOTTLES VIAL, PLASTIC, AMBER 60ML|16DR 200'S B 62.90 0.31 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43749 VIAL, PLASTIC, AMBER 60ML/16DR (DCN) BOTTLES VIAL, PLASTIC, AMBER 60ML|16DR 200'S B 66.25 0.3312 EACH 4 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43749 VIAL, PLASTIC, AMBER 60ML/16DR (DCN) BOTTLES VIAL, PLASTIC, AMBER 60ML|16DR 200'S B 75.30 0.38 EACH 4 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43757 VIAL, PLASTIC AMBER 90ML/30DR (DCN/COL) BOT BOTTLES VIAL, PLASTIC AMBER 90ML|30DR 100'S B 48.33 0.48 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43757 VIAL, PLASTIC AMBER 90ML/30DR (DCN) BOTTLES VIAL, PLASTIC AMBER 90ML|30DR 100'S B 50.86 0.5086 EACH 4 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43757 VIAL, PLASTIC AMBER 90ML/30DR (DCN) BOTTLES VIAL, PLASTIC AMBER 90ML|30DR 100'S B 57.79 0.58 EACH 4 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43766 VIAL, PLASTIC AMBER 50ML | 14DR (DCN/COL) BOT BOTTLES VIAL, PLASTIC AMBER 50ML|14DR 200'S B 48.22 0.24 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES
41 43766 VIAL, PLASTIC AMBER 50ML|14DR (DCN) BO (B) BOTTLES VIAL, PLASTIC AMBER 50ML|14DR 200'S B 51.46 0.2573 EACH 0 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 0 MEDICAL DEVICES
42 43766 VIAL, PLASTIC AMBER 50ML|14DR (DCN) BO BOTTLES VIAL, PLASTIC AMBER 50ML|14DR 200'S B 118.95 0.59 EACH 0 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 2028-03-31 0 MEDICAL DEVICES
40 43773 VIAL, PLASTIC, AMBER 140ML/40DR (DCN/COL) BOTTLES VIAL, PLASTIC, AMBER 140ML|40D 100'S B 61.38 0.61 0 EACH DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2022-04-01 2024-03-31 0 MEDICAL DEVICES