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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 4181BE KEYTRUDA 25MG/ML INJ (MSD/STO) PEMBROLIZUMAB PEMBROLIZUMAB KEYTRUDA 4ML VIAL C 9,766.50 9,766.50 INJECTION 0 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181BE KEYTRUDA 25MG/ML INJ (MSD) PEMBROLI (C) PEMBROLIZUMAB KEYTRUDA 4ML VIAL C 9766.5 9766.5032 VIAL 0 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS