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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 A1813 ELECTROLYTES SOLN (BAX/STO) ELECTROLYTES ELECTROLYTES 1 LITRE BQ 13.86 13.86 SOLUTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 A1813 ELECTROLYTES SOLN (BAX) ELECTROLYTES ELECTROLYTES 1 LITRE BQ 16.26 16.2556 BOTT 50 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 6 REPLACEMENT THERAPY
42 A1813 ELECTROLYTES SOLN (BAX) ELECTROLYTES CARDIOPLEGIC 1 LITRE BQ 5.06 5.06 BOTT 50 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2026-04-01 IV 0 REPLACEMENT THERAPY