Displaying 1 - 5 of 5
  • 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 37314 ADACEL TDaP INJ (AVP/COL) DIP/TET/PERT ACELL ACELLULAR PERTUSSIS|DIPHTHERIA|TETANUS TOXOID ADACEL TDaP 1 DOSE B $41.59 $41.59 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
40 37617 TYPHIM V1 (AVP/COL) TYPHOID SALMONELLA TYPHI TYPHIM V1 1 DS SYRNG B $31.80 $31.80 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2022-04-01 2024-03-31 IM 0 SERUMS, TOXOIDS AND VACCINES
40 46121 IMOVAX POLIO (AVP/COL) POLIOMYELITIS POLIOMYELITIS IMOVAX POLIO 1 DOSE B $24.46 $24.46 INJECTION 0 PFS AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2022-04-01 2024-03-31 IM 0 SERUMS, TOXOIDS AND VACCINES
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
40 79714 ACT-HIB 24MCG | 10MCG INJ (AVP/COL) DIPHTHERIA TOXOID | HAEMOPHILUS B DIPHTHERIA TOXOID|HAEMOPHILUS B ACT-HIB 1 DS SYRNG B $19.57 $19.57 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES