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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 5511AS NOVOFINE 32G (NOV/COL) PEN NEEDLES PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.45 0 EACH NOV NOVO NORDISK A/S COL COLLINS LTD 682008 INSULINS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 5511AS NOVOFINE 32G (NOV) PEN NEEDLES (C) PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.4453 EACH 0 BOX NOV NOVO NORDISK A/S COL COLLINS LTD 682008 INSULINS 2024-04-01 2026-03-31 IV 0 INSULINS
42 5511AS NOVOFINE 32G (NOV) PEN NEEDLES PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.45 EACH 0 BOX NOV NOVO NORDISK A/S COL AVENTA BARBADOS 682008 INSULINS 2026-04-01 IV 0 INSULINS
42 5511AX ACCU-FINE 32G (PRI) PEN NEEDLES PEN NEEDLES ACCU-FINE 100'S B 26.34 0.26 EACH 10 BOX PRI PRODUCTOS ROCHE INTERAMERICANA SA STO BRYDEN STOKES LTD 682008 INSULINS 2026-04-01 0 INSULINS