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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 A3131 SAIZEN 6MG INJ (MEK/COL) SOMATROPIN SOMATROPIN SAIZEN VIAL C 247.10 247.10 INJECTION 0 VIAL MEK MERCK SERONO COL COLLINS LTD 683004 SOMATROPHIN AGONIST 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES