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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 A2921 ARAVA 20MG TAB (SFA/COL) LEFLUNOMIDE LEFLUNOMIDE ARAVA 30'S C 95.14 3.17 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 A2921 ARAVA 20MG TAB (SFA) LEFLUNOMIDE (C) LEFLUNOMIDE ARAVA 30'S C 95.14 3.1714 TAB 0 BOX SFA SANOFI AVENTIS COL COLLINS LTD 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2024-04-01 2026-03-31 ORAL 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS
42 A2921 ARAVA 20MG TAB (SFA) LEFLUNOMIDE LEFLUNOMIDE ARAVA 30'S C 95.14 3.17 TAB 0 BLIS SFA SANOFI COL AVENTA BARBADOS 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2026-04-01 ORAL 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS