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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 6781R ETOPOSIDE 20MG/ML INJ (INP/AHI) ETOPOSIDE ETOPOSIDE 5ML VIAL BQ 17.21 17.21 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 6781W ZUVITOP 20MG/ML INJ (ZUV) ETOPOSIDE ETOPOSIDE ZUVITOP 5ML VIAL BQ 12.29 12.2868 VIAL 40 VIAL ZUV ZUVIUS PHA PHARMACY SALES CARIBBEAN 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
41 67827 ZUVITOP 50MG CAP (ZUV) ETOPOSIDE ETOPOSIDE ZUVITOP 20'S BQ 32.18 1.6092 CAP 10 BOTT ZUV ZUVIUS PHA PHARMACY SALES CARIBBEAN 1000 ANTINEOPLASTICS 2024-04-01 2024-05-17 ORAL 6 ANTINEOPLASTICS 2024-04-05
41 67828 ZUVITOP 50MG TAB (ZUV) ETOPOSIDE ETOPOSIDE ZUVITOP 8'S BQ 26.34 3.2925 TAB 10 BOX ZUV ZUVIUS PHA PHARMACY SALES CARIBBEAN 1000 ANTINEOPLASTICS 2024-04-05 2026-03-31 ORAL 6 ANTINEOPLASTICS 2024-04-05