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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 5962A TRAJENTAMET 2.5MG|850MG TAB (BOE) LINAGLIPTIN|METFORMIN LINAGLIPTIN|METFORMIN TRAJENTAMET 60'S C 114.66 1.91 TAB 0 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
42 5963Q TRAJENTAMET 2.5MG|1000MG TAB (BOE) LINAGLIPTIN|METFORMIN LINAGLIPTIN|METFORMIN TRAJENTAMET 60'S C 114.66 1.91 TAB 0 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS