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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
42 1151B TRILIPIX 135MG DR CAP (ABB) FENOFIBRATE FENOFIBRATE TRILIPIX 3X10 C 89.70 2.99 CAP 0 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 240606 FIBRIC ACID DERIVATIVES 2026-04-01 ORAL 0 FIBRIC ACID DERIVATIVES