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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 4181BY KESIMPTA 20MG INJ (NVS) OFATUMUMAB OFATUMUMAB KESIMPTA 0.4ML VIAL BQ 3,794.29 3,794.29 VIAL 0 VIAL NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 SC 0 ANTINEOPLASTICS