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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 30316 ADRENALINE | LIDOCAINE 0.001% | 1% INJ (FSB/ATB) ADRENALINE|LIDOCAINE ADRENALINE|LIDOCAINE 30ML B 3.94 3.94 INJECTION 0 VIAL FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 7200 LOCAL ANESTHETICS 2022-04-01 2024-03-31 Add to Contract as Cat B IV 0 LOCAL ANESTHETICS 2021-11-18
41 30317 ADRENALINE|LIDOCAINE 0.001%|1% INJ (KWA) ADRENALINE|LIDOCAINE ADRENALINE|LIDOCAINE 30ML B 7.4754 7.4754 VIAL 0 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 7200 LOCAL ANESTHETICS 2024-04-01 2026-03-31 IV 0 LOCAL ANESTHETICS
40 3032C ADRENALINE | LIDOCAINE 0.001% | 2% INJ (FSB/ATB) ADRENALINE|LIDOCAINE ADRENALINE|LIDOCAINE 30ML B 4.08 4.08 INJECTION 0 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 7200 LOCAL ANESTHETICS 2022-04-01 2024-03-31 Add to Contract as Cat B IV 0 LOCAL ANESTHETICS 2021-11-18