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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 A5213 SURVANTA 25MG/ML INJ (ABB/PHA) BERACTANT BERACTANT SURVANTA 8ML VIAL BQ 1,043.59 1,043.59 INJECTION 0 VIAL ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 4836 PULMONARTY SURFCTANTS 2022-04-01 2024-03-31 IV 0 RESPIRATORY TRACT AGENTS
41 A5213 SURVANTA 25MG/ML INJ (ABB) BERACTANT (BQ) BERACTANT SURVANTA 8ML VIAL BQ 1042.4 1042.3957 VIAL 50 VIAL ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 4836 PULMONARTY SURFCTANTS 2024-04-01 2026-03-31 IV 0 PULMONARTY SURFCTANTS
42 A5213 SURVANTA 25MG/ML INJ (ABB) BERACTANT BERACTANT SURVANTA 8ML VIAL BQ 992.19 992.19 VIAL 50 VIAL ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 4836 PULMONARTY SURFCTANTS 2026-04-01 IV 0 PULMONARTY SURFCTANTS