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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 A5916 DOXORUBICIN 50MG SOLN FOR INJ (EBA/COL) DOXORUBICIN DOXORUBICIN 50MG VIAL BQ 34.93 34.93 SOLUTION FOR 0 VIAL EBA EBEW ARZNEIMITTLE GES.MBH COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Price Change IV 0 ANTINEOPLASTICS 2022-01-18
40 A591AA DOXORUBICIN 50MG SOLN FOR INJ (DIL/AHI) DOXORUBICIN DOXORUBICIN 50MG VIAL BQ 25.91 25.91 SOLUTION FOR 0 VIAL DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 A591AH DOXOTHER 50MG SOLN FOR INJ (TPP/AHI) DOXORUBICIN DOXORUBICIN DOXOTHER 50ML VIAL BQ 18.46 18.46 SOLUTION FOR 0 VIAL TPP THERDOSE PHARMA PRIVATE LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS