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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
42 2991T SYNTHROID 0.1MG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 7.34 0.24 TAB 60 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 6836 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 2991V EUTIROX NF 100MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 1000'S A 81.55 0.08 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
40 29931 EUTIROX 25MCG TAB (MEK/COL) THYROXINE THYROXINE EUTIROX 50'S A 13.18 0.26 TABLET 90 TAB MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 29931 EUTIROX 25MCG TAB (MEK) THYROXINE THYROXINE EUTIROX 50'S A 13.18 0.2637 TAB 90 BOX MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 THYROID AGENTS
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C 5.71 0.19 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C 5.71 0.1903 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02
41 2993C SYNTHROID 25MCG TAB (ABB) THYROXINE THYROXINE SYNTHROID 30'S A 5.98 0.1993 TAB 90 BOX ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 THYROID AGENTS
42 2993C SYNTHROID 25MCG TAB (ABB) THYROXINE THYROXINE SYNTHROID 30'S A 5.44 0.18 TAB 90 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 2993E EUTIROX NF 25MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 13.51 0.27 TAB 90 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
40 29941 EUTIROX 50MCG TAB (MEK/COL) THYROXINE THYROXINE EUTIROX 50'S A 15.98 0.32 TABLET 90 TAB MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 29941 EUTIROX 50MCG TAB (MEK) THYROXINE THYROXINE EUTIROX 50'S A 15.98 0.3197 TAB 90 BOX MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 THYROID AGENTS
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C 7.29 0.24 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C 7.29 0.243 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02
41 2994C SYNTHROID 50MCG TAB (ABB) THYROXINE THYROXINE SYNTHROID 30'S A 7.64 0.2546 TAB 90 BOX ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 THYROID AGENTS
42 2994C SYNTHROID 50MCG TAB (ABB) LEVOTHYROXINE LEVOTHYROXINE SYNTHROID 30'S A 6.93 0.23 TAB 90 BLIS ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
42 2994G EUTIROX NF 50MCG TAB (MEK) LEVOTHYROXINE LEVOTHYROXINE EUTIROX NF 50'S A 16.36 0.33 TAB 90 BLIS MEK MERCK SERONO COL AVENTA BARBADOS 683604 THYROID AGENTS 2026-04-01 2028-03-31 ORAL 6 THYROID AGENTS
40 29951 EUTIROX 75MCG TAB (MEK/COL) THYROXINE THYROXINE EUTIROX 50'S A 18.27 0.37 TABLET 90 TAB MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 29951 EUTIROX 75MCG TAB (MEK) THYROXINE THYROXINE EUTIROX 50'S A 18.54 0.3708 TAB 90 BOX MEK MERCK SERONO COL COLLINS LTD 683604 THYROID AGENTS 2024-04-01 2026-03-31 ORAL 6 THYROID AGENTS
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C 7.39 0.25 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C 7.39 0.2463 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02