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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 A531W SAFLUTAN 0.015MG/ML EYE DR (MSD/STO) TAFLUPROST TAFLUPROST SAFLUTAN 30X0.3ML B 36.43 36.43 EYE DROP 0 AMP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS