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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 59613 GALVUSMET 500MG | 50MG TAB (NVS/COL) METFORMIN | VIDAGLIPTIN METFORMIN|VIDAGLIPTIN GALVUSMET 56'S B 32.62 0.58 TABLET 60 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
40 59623 GALVUSMET 850MG | 50MG TAB (NVS/COL) METFORMIN | VIDAGLIPTIN METFORMIN|VIDAGLIPTIN GALVUSMET 56'S B 32.62 0.58 TABLET 60 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
40 59633 GALVUSMET 1G | 50MG TAB (NVS/COL) METFORMIN | VIDAGLIPTIN METFORMIN|VIDAGLIPTIN GALVUSMET 56'S B 32.62 0.58 TABLET 60 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES