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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 63416 STAMARIL (AVP/COL) YELLOW FEVER YELLOW FEVER VIRUS STAMARIL 1 DS SYRNG B 53.82 53.82 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2022-04-01 2024-03-31 IM 0 SERUMS, TOXOIDS AND VACCINES
41 63416 STAMARIL (AVP) YELLOW FEVER YELLOW FEVER VIRUS STAMARIL 1 DS VIAL B 53.82 53.8228 VIAL 20 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2024-04-01 2024-10-21 IM 0 VACCINES 2024-09-09