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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 64356 FOLINIC ACID 15MG TAB (ZUV) FOLINIC ACID FOLINIC ACID 10'S BQ 16.80 1.68 TAB 0 BLIS ZUV ZUVIUS PHA PHARMACY SALES CARIBBEAN 9212 ANTIDOTES 2026-04-01 ORAL 0 ANTIDOTES