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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 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 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 0 MEDICAL DEVICES