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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 1011AE HEPARIN 5000U/ML INJ (BRA/COL) HEPARIN HEPARIN 10X5ML B 156.98 15.70 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 1011AE HEPARIN 5000U/ML INJ (BRA) (B) HEPARIN HEPARIN 10X5ML B 165.82 16.5818 VIAL 0 BOX BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 20120416 HEPARINS 2024-04-01 2026-03-31 IV 0 HEPARINS
41 1011H HEPARIN 5000U/ML INJ (GLN) (B) HEPARIN HEPARIN 25X5ML B 252.29 10.0915 VIAL 0 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 0 HEPARINS
40 1011J HEPARIN 5000U/ML INJ (RTM/PHA) HEPARIN HEPARIN 5ML VIAL B 12.23 12.23 INJECTION 0 VIAL RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 20120416 HEPARINS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 1011J HEPARIN 5000U/ML INJ (RTM) (B) HEPARIN HEPARIN 5ML VIAL B 15.39 15.3857 VIAL 0 VIAL RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 20120416 HEPARINS 2024-04-01 2026-03-31 IV 0 HEPARINS