Displaying 1 - 2 of 2
  • 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 72212 AVONEX 30MCG/ML INJ (BGN/PHA) INTERFERON BETA 1A INTERFERON BETA 1A AVONEX 4X30MCG C 2,560.66 2,560.66 INJECTION 0 VIAL BGN BIOGEN PHA PHARMACY SALES CARIBBEAN 081820 INTERFERONS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
41 72212 AVONEX 30MCG/ML INJ (BGN) INTERFERON BETA 1A (BQ) INTERFERON BETA 1A AVONEX 4X30MCG BQ 2611.87 2611.8744 VIAL 0 VIAL BGN BIOGEN PHA PHARMACY SALES CARIBBEAN 081820 INTERFERONS 2024-04-01 2026-03-31 IV 0 INTERFERONS