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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 5511AS NOVOFINE 32G (NOV/COL) PEN NEEDLES PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.45 0 EACH NOV NOVO NORDISK A/S COL COLLINS LTD 682008 INSULINS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 5511AS NOVOFINE 32G (NOV) PEN NEEDLES (C) PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.4453 EACH 0 BOX NOV NOVO NORDISK A/S COL COLLINS LTD 682008 INSULINS 2024-04-01 2026-03-31 IV 0 INSULINS
42 5511AS NOVOFINE 32G (NOV) PEN NEEDLES PEN NEEDLES NOVOFINE 32G 100'S C 44.53 0.45 EACH 0 BOX NOV NOVO NORDISK A/S COL AVENTA BARBADOS 682008 INSULINS 2026-04-01 IV 0 INSULINS
40 71331 NOVONORM 2MG TAB (NOV/COL) REPAGLINIDE REPAGLINIDE NOVONORM 30'S C 27.18 0.91 TABLET 0 TAB NOV NOVO NORDISK A/S COL COLLINS LTD 682016 MEGLITINIDES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 71331 NOVONORM 2MG TAB (NOV) REPAGLINIDE REPAGLINIDE NOVONORM 30'S C 27.18 0.9061 TAB 0 BOX NOV NOVO NORDISK A/S COL COLLINS LTD 682016 MEGLITINIDES 2024-04-01 2026-03-31 ORAL 0 MEGLITINIDES
40 B2214 NOVORAPID FLEXPENS 100U/ML (NOV/COL) ASPART ASPART NOVORAPID FLEXPENS 5X3ML A 88.35 17.67 INJECTION 1 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2214 NOVORAPID FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVORAPID FLEXPENS 5X3ML A 88.35 17.67 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2214 NOVORAPID FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVORAPID FLEXPENS 5X3ML A 88.35 17.67 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 Amend Protocol Quantity SC 6 INSULINS 2026-04-21
40 B2223 NOVOLIN-R 100U/ML INJ (NOV/COL) INSULIN RAPID INSULIN RAPID NOVOLIN-R 10ML VIAL A 11.96 11.96 INJECTION 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2223 NOVOLIN-R 100U/ML INJ (NOV) INSULIN SHORT ACTING INSULIN REGULAR NOVOLIN-R 10ML VIAL A 11.96 11.9606 VIAL 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS 2024-04-01
42 B2223 NOVOLIN-R 100U/ML INJ (NOV) INSULIN REGULAR INSULIN REGULAR NOVOLIN-R 10ML VIAL A 11.96 11.96 VIAL 5 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS
40 B2232 NOVOLIN-N 100U/ML INJ (NOV/COL) INSULIN ISOPH INSULIN ISOPHANE NOVOLIN-N 10ML VIAL A 11.96 11.96 INJECTION 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOP INSULIN ISOPHANE NOVOLIN-N 10ML VIAL A 11.96 11.9606 VIAL 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOPHANE INSULIN ISOPHANE NOVOLIN-N 10ML VIAL A 11.96 11.96 VIAL 5 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS
40 B2241 LEVEMIR PEN 100U/ML INJ (NOV/COL) DETEMIR DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.88 INJECTION 1 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2241 LEVEMIR PEN 100U/ML INJ (NOV) DETEMIR INSULIN DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.878 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2241 LEVEMIR PEN 100U/ML INJ (NOV) INSULIN DETEMIR INSULIN DETEMIR LEVEMIR PEN 5X3ML A 129.39 25.88 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS
40 B2252 NOVOLIN 70% | 30% INJ (NOV/COL) INSULIN ISOPHANE | INSULIN REGULAR INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN 10ML VIAL A 11.96 11.96 INJECTION 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2252 NOVOLIN 70%|30% INJ (NOV) INSULIN ISOPHANE|INSULIN REGULAR INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN 10ML VIAL A 11.96 11.9606 VIAL 5 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2252 NOVOLIN 70%|30% INJ (NOV) INSULIN ISOPHANE|INSULIN REGULAR INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN 10ML VIAL A 11.96 11.96 VIAL 5 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 SC 6 INSULINS