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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 35463 PEDIA POLY-VITE W | IRON DROPS (BYP/PHA) MULTIVITAMINS PAEDIATRIC WITH IRON MULTIVITAMINS PAEDIATRIC WITH IRON PEDIA POLY-VITE W|IRON 50ML A 10.79 10.79 DROPS 1 BOTT BYP BAYSHORE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Oral 6 VITAMINS
41 35463 PEDIA POLY-VITE W|IRON DROPS (BYP) MULTIVITAMINS PAEDIATRIC MULTIVITAMINS PAEDIATRIC WITH IRON PEDIA POLY-VITE W|IRON 50ML A 11.66 11.66 BOTT 1 BOTT BYP BAYSHORE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 6 MULTIVITAMIN PREPARATIONS 2023-09-12