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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 5062AJ REHYDRATION SALTS (HEA/ATB) GLUCOSE|POTASSIUM CHLORIDE|SODIUM CHLORIDE|SODIUM CITRATE REHYDRATION SALTS 30'S A 18.62 0.6207 SACHET HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2022-12-07 2024-03-31 Change Local Agent ORAL 0 REPLACEMENT THERAPY 2022-11-25