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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 37314 ADACEL TDaP INJ (AVP/COL) DIP/TET/PERT ACELL ACELLULAR PERTUSSIS|DIPHTHERIA|TETANUS TOXOID ADACEL TDaP 1 DOSE B 41.59 41.59 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 37314 ADACEL TDaP INJ (AVP) DIP/TET/PERT ACEL (B) ACELLULAR PERTUSSIS|DIPHTHERIA|TETANUS TOXOID ADACEL TDaP 1 DOSE B 39.14 39.1439 VIAL 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2024-04-01 2024-10-21 IV 0 VACCINES 2024-09-09