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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 65811 LECTRUM 11.25MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM KIT C 462.31 462.31 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE (BQ) LEUPROLIDE LECTRUM KIT BQ 462.31 462.3054 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM KIT BQ 466.87 466.87 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 IV 0 ANTINEOPLASTICS
40 6581C LECTRUM 3.75MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.97 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE (BQ) LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.9727 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.97 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 IV 0 ANTINEOPLASTICS
40 6581D LECTRUM 7.5MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.04 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE (C) LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.0397 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.04 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 IV 0 ANTINEOPLASTICS