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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 3791J ALLEGRA -D 120MG F/60MG P TAB (SFA/COL) FEXOF FEXOFENADINE|PSEUDOEPHEDRINE ALLEGRA -D 10'S C 11.15 1.12 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 3791J ALLEGRA -D 120MG F/60MG P TAB (SFA/COL) FEXOF (C) FEXOFENADINE|PSEUDOEPHEDRINE ALLEGRA -D 10'S C 14.54 1.454 TABLET IMMED SFA SANOFI AVENTIS COL COLLINS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-10 2024-03-31 Price Change Oral 0 SECOND GENERATION ANTIHISTAMINES 2022-12-09