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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 4331L AFINITOR 5MG TAB (NVS/COL) EVEROLIMUS EVEROLIMUS AFINITOR 30'S C 5,436.65 181.22 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
41 4331L AFINITOR 5MG TAB (NVS) EVEROLIMUS (C) EVEROLIMUS AFINITOR 30'S C 5164.82 172.1605 TAB 0 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 ORAL 0 ANTINEOPLASTICS
40 4331M AFINITOR 10MG TAB (NVS/COL) EVEROLIMUS EVEROLIMUS AFINITOR 30'S C 15,490.2 516.34 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
41 4331M AFINITOR 10MG TAB (NVS) EVEROLIMUS (C) EVEROLIMUS AFINITOR 30'S C 10329.63 344.321 TAB 0 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 ORAL 0 ANTINEOPLASTICS