Displaying 1 - 6 of 6
  • Print
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 A0811 PNEUMOVAX 23 INJ (MSD/STO) PNEUMOCOCCAL STREPTOCOCCUS PNEUMONIA TYPES PNEUMOVAX 0.5ML VIAL C 23.98 23.98 INJECTION 0 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8012 VACCINES 2022-07-26 2024-03-31 Package Size Change IM SERUMS, TOXOIDS AND VACCINES 2022-07-26
41 A0811 PNEUMOVAX 23 INJ (MSD) PNEUMOCOCCAL STREPTOCOCCUS PNEUMONIA TYPES PNEUMOVAX 0.5ML VIAL B 24.68 24.6824 VIAL 1 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8012 VACCINES 2024-04-01 2026-03-31 IM 0 VACCINES
40 A0825 PREVNAR 13 16MCG INJ (PFI/STO) PNEUMOCOCCAL STREPTOCOCCUS PNEUMONIA TYPES PREVNAR 13 1 DOSE B 176.23 176.23 INJECTION 0 VIAL PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 8012 VACCINES 2022-04-01 2022-06-21 IV 0 SERUMS, TOXOIDS AND VACCINES
40 A0825 PREVNAR 13 16MCG INJ (PFI/STO) PNEUMOCOCCAL STREPTOCOCCUS PNEUMONIA TYPES PREVNAR 13 1 DOSE B 223.12 223.12 INJECTION 0 VIAL PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 8012 VACCINES 2022-06-22 2024-03-31 Price Change IV 0 SERUMS, TOXOIDS AND VACCINES 2022-06-22
41 A0825 PREVNAR 13 16MCG INJ (PFI) PNEUMOCOCCAL STREPTOCOCCUS PNEUMONIA TYPES PREVNAR 13 1 DOSE B 177.94 177.9415 VIAL 1 VIAL PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 8012 VACCINES 2024-04-01 2026-03-31 IV 0 VACCINES
42 A0825 PREVNAR 13 16MCG INJ (PFI) STREPTOCOCCUS PNEUMONIA TYPES STREPTOCOCCUS PNEUMONIA TYPES PREVNAR 13 0.5ML PFS B 177.94 177.94 PFS 0 VIAL PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 8012 VACCINES 2026-04-01 IV 0 VACCINES