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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 79714 ACT-HIB 24MCG | 10MCG INJ (AVP/COL) DIPHTHERIA TOXOID | HAEMOPHILUS B DIPHTHERIA TOXOID|HAEMOPHILUS B ACT-HIB 1 DS SYRNG B 19.57 19.57 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 79714 ACT-HIB 24MCG|10MCG INJ (AVP) DIPHTHERIA TOXOID|HAEMOPHILUS (B) DIPHTHERIA TOXOID|HAEMOPHILUS B ACT-HIB 1 DS VIAL B 19.57 19.5719 VIAL 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2024-04-01 2024-10-21 IV 0 VACCINES 2024-09-09