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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
41 43729 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN) (B) Vials VIAL, PLASTIC, AMBER 25ML/7 DR 500'S B 83.1 0.1662 EACH 0 BOX DCN DCN PLASTICS COL COLLINS LTD 9400 MEDICAL DEVICES 2024-04-01 2026-03-31 ORAL 0 MEDICAL DEVICES
42 43729 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN) VIALS VIALS VIAL, PLASTIC, AMBER 25ML/7 DR 500'S B 94.43 0.19 EACH 0 BOX DCN DCN PLASTICS COL AVENTA BARBADOS 9400 MEDICAL DEVICES 2026-04-01 ORAL 0 MEDICAL DEVICES