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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 5201EP DUREX INTENSE SENSATION (SSA/STO) CONDOM CONDOM DUREX INTENSE SENSATION 3'S C 4.32 1.44 CONDOM 0 EACH SSA SSL AMERICAS INC STO BRYDEN STOKES LTD 6813 CONDOMS 2022-04-01 2024-03-31 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 5201ER DUREX EXTRA SENSITIVE RIBBED (SSA/STO) COND CONDOM DUREX EXTRA SENSITIVE RIBBED 3'S C 3.72 1.24 CONDOM 0 EACH SSA SSL AMERICAS INC STO BRYDEN STOKES LTD 6813 CONDOMS 2022-04-01 2024-03-31 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 5201EZ DUREX PERFORMAX INTENSE (SSA/STO) CONDOM CONDOM DUREX PERFORMAX INTENSE 3'S C 4.43 1.48 CONDOM 0 EACH SSA SSL AMERICAS INC STO BRYDEN STOKES LTD 6813 CONDOMS 2022-04-01 2024-03-31 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 5201FQ DUREX INVISIBLE (SSA/STO) CONDOM CONDOM DUREX INVISIBLE 3'S C 5.76 1.92 0 EACH SSA SSL AMERICAS INC STO BRYDEN STOKES LTD 6813 CONDOMS 2022-04-01 2024-03-31 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 5201GJ DUREX REAL FEEL AVANTI BARE CONDOM (SSA/STO) CONDOM DUREX REAL FEEL AVANTI BARE 3'S C 5.76 1.92 CONDOM 0 EACH SSA SSL AMERICAS INC STO BRYDEN STOKES LTD 6813 CONDOMS 2022-04-01 2024-03-31 0 HORMONES AND SYNTHETIC SUBSTITUTES