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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 B1516 ELIQUIS 2.5MG TAB (PFI/STO) APIXABAN APIXABAN ELIQUIS 60'S C 219.40 3.66 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 B1516 ELIQUIS 2.5MG TAB (PFI) APIXABAN (B) APIXABAN ELIQUIS 60'S B 175.33 2.9222 TAB 60 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2024-04-01 2026-03-31 ORAL 6 DIRECT THROMBIN INHIBITORS
40 B1526 ELIQUIS 5MG TAB (PFI/STO) APIXABAN APIXABAN ELIQUIS 60'S C 219.40 3.66 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 B1526 ELIQUIS 5MG TAB (PFI) APIXABAN (B) APIXABAN ELIQUIS 60'S B 175.33 2.9222 TAB 60 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2024-04-01 2026-03-31 ORAL 6 DIRECT THROMBIN INHIBITORS