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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 59617 KOMBIGLYZE 1G | 2.5MG TAB (AZN/COL) METFORMIN | SAXAGLIPTIN METFORMIN|SAXAGLIPTIN KOMBIGLYZE 28'S C 51.65 1.84 TABLET 0 TAB AZN ASTRAZENECA AB COL COLLINS LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 59637 KOMBIGLYZE 1G | 5MG TAB (AZN/COL) METFORMIN | SAXAGLIPTIN METFORMIN|SAXAGLIPTIN KOMBIGLYZE 28'S C 51.65 1.84 TABLET 0 TAB AZN ASTRAZENECA AB COL COLLINS LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 59637 KOMBIGLYZE 1G|5MG TAB (AZN) METFORMIN|SAXAGLIPTIN (C) METFORMIN|SAXAGLIPTIN KOMBIGLYZE 28'S C 54.23 1.9368 TAB 0 BOX AZN ASTRAZENECA AB COL COLLINS LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
42 59637 KOMBIGLYZE 1G|5MG TAB (AZN) METFORMIN|SAXAGLIPTIN METFORMIN|SAXAGLIPTIN KOMBIGLYZE 28'S C 56.95 2.03 TAB 0 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS