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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 A911S PEG-GRAFEEL 6MG INJ (DRL/AAL) PEGFILGRASTIM PEGFILGRASTIM PEG-GRAFEEL 1 DS SYRNG BQ 419.93 419.93 INJECTION 0 PFS DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 A911S PEG-GRAFEEL 6MG INJ (DRL) PEGFILGRA (BQ) PEGFILGRASTIM PEG-GRAFEEL 1 DS SYRNG BQ 380.57 380.5654 PFS 0 BOX DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 2016 HEMATOPOIETIC 2024-04-01 2026-03-31 IV 0 HEMATOPOIETIC