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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 05752 ENDOXAN 1G INJ (ASM/COL) CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE ENDOXAN 1G VIAL BQ 38.06 38.06 INJECTION 0 VIAL ASM ASTA MEDICA AG COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS