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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 05415 BLEOMYCIN SULPHATE 15MG INJ (CIP/AHI) BLEOMYCIN SULPHATE BLEOMYCIN SULPHATE 15MG VIAL BQ 44.85 44.85 INJECTION 0 VIAL CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 0541E BLEOMYCIN SULPHATE 15MG INJ (KWA) (BQ) BLEOMYCIN SULPHATE BLEOMYCIN SULPHATE 15MG VIAL BQ 34.01 34.0062 VIAL 30 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 6 ANTINEOPLASTICS