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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 1121KB PMS-CHOLESTYRAMINE GRANUL (PMS/COL) CHOLESTYRAMINE PMS-CHOLESTYRAMINE 30X4G A 43.49 1.45 GRANULES 60 SACH PMS PHARMASCIENCE COL COLLINS LTD 240604 BILE ACID SEQUESTRANTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 1121KB PMS-CHOLESTYRAMINE 4G GRAN (PMS) CHOLESTYRAMINE PMS-CHOLESTYRAMINE 30X4G A 53.01 1.7669 SACH 60 BOX PMS PHARMASCIENCE COL COLLINS LTD 240604 BILE ACID SEQUESTRANTS 2024-04-01 2026-03-31 ORAL 6 BILE ACID SEQUESTRANTS