Displaying 1 - 11 of 11
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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
42 2991T SYNTHROID 0.1MG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 7.34 0.24 TAB 60 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 6836 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 2991V EUTIROX NF 100MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 1000'S A 81.55 0.08 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 2993E EUTIROX NF 25MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 13.51 0.27 TAB 90 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 2994C SYNTHROID 50MCG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 6.93 0.23 TAB 90 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 2994G EUTIROX NF 50MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 16.36 0.33 TAB 90 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 29958 SYNTHROID 75MCG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 7.04 0.23 TAB 90 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 2995B EUTIROX NF 75MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 18.73 0.37 TAB 90 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 29963 SYNTHROID 125MCG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 7.75 0.26 TAB 30 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 29964 EUTIROX NF 125MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 21.12 0.42 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 29973 SYNTHROID 150MCG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 8.02 0.27 TAB 30 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS
42 29974 EUTIROX NF 150MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 21.12 0.42 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 ORAL 6 THYROID AGENTS