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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 B2241 LEVEMIR PEN 100U/ML INJ (NOV/COL) DETEMIR DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.88 INJECTION 1 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2241 LEVEMIR PEN 100U/ML INJ (NOV) DETEMIR INSULIN DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.878 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2241 LEVEMIR PEN 100U/ML INJ (NOV) INSULIN DETEMIR INSULIN DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.88 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS