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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
41 B2214 NOVORAPID FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVORAPID FLEXPENS 5X3ML A 88.35 17.67 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2214 NOVORAPID FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVORAPID FLEXPENS 5X3ML A 88.35 17.67 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 Amend Protocol Quantity SC 6 INSULINS 2026-04-21
41 B2255 NOVOMIX 70/30 PENFILLS 100U/ML INJ (NOV) ASPART INSULIN ASPART NOVOMIX 70/30 PENFILLS 5X3ML A 122.32 24.4649 VIAL 2 BOX NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
41 B2256 NOVOMIX 70|30 FLEXPENS 100U/ML INJ (NOV) ASPART INSULIN ASPART NOVOMIX 70|30 FLEXPENS 5X3ML A 122.32 24.464 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS 2024-03-05
42 B2256 NOVOMIX 70|30 FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVOMIX 70|30 FLEXPENS 5X3ML A 122.32 24.46 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS