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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 31715 HUMIRA AC PEN 40MG INJ (ABB/PHA) ADALIMUMAB ADALIMUMAB HUMIRA AC PEN 2X40MG C 2,144.38 2,144.38 INJECTION 0 PFS ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 31715 HUMIRA AC PEN 40MG INJ (ABB) ADALIMUMAB (C) ADALIMUMAB HUMIRA AC PEN 2X40MG C 2141.9 1070.9517 PFS 0 BOX ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2024-04-01 2026-03-31 IV 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS
41 31716 HYRIMOZ 40MG INJ (BCH) ADALIMUMAB (C) ADALIMUMAB HYRIMOZ 2X40MG C 1202.04 601.0214 BOX 0 PFS BCH SANDOZ COL COLLINS LTD 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2024-04-01 2026-03-31 IV 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS
40 31717 ADALIREL 40MG INJ (RLS/AHI) ADALIMUMAB ADALIMUMAB ADALIREL 0.8ML SYRN C 875.30 875.30 INJECTION 0 PFS RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS