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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 B2212 APIDRA SOLOSTAR 100IU/ML INJ (SFA/COL) GLULIS GLULISINE APIDRA SOLOSTAR 3ML VIAL A 19.71 19.71 INJECTION 4 VIAL SFA SANOFI AVENTIS COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2212 APIDRA SOLOSTAR 100U/ML INJ (SFA) INSULIN GLULISINE INSULIN GLULISINE APIDRA SOLOSTAR 3ML VIAL A 19.71 19.7078 VIAL 2 VIAL SFA SANOFI AVENTIS COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2212 APIDRA SOLOSTAR 100U/ML INJ (SFA) INSULIN GLULISINE INSULIN GLULISINE APIDRA SOLOSTAR 3ML VIAL A 19.71 19.71 VIAL 2 VIAL SFA SANOFI COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS
40 B2213 APIDRA 100U/ML INJ (SFA/COL) GLULISINE GLULISINE APIDRA 10ML VIAL A 54.37 54.37 INJECTION 5 VIAL SFA SANOFI AVENTIS COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2213 APIDRA 100U/ML INJ (SFA) INSULIN GLULISINE INSULIN GLULISINE APIDRA 10ML VIAL A 54.37 54.3665 VIAL 5 VIAL SFA SANOFI AVENTIS COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2213 APIDRA 100U/ML INJ (SFA) INSULIN GLULISINE INSULIN GLULISINE APIDRA 10ML VIAL A 54.37 54.37 VIAL 5 VIAL SFA SANOFI COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS