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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 0142B ERYTHROMYCIN 5% EYE OINT (AKI/AHI) ERYTHROMYCIN ERYTHROMYCIN 3.5G C 67.31 67.31 EYE OINTMENT 0 TUBE AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 0152BF
41 0152BF AMOXIL 25MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 12.61 0.1261 SUSP 300 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0152BF AMOXIL 25MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 11.47 0.11 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0152BQ AMOXICILLIN 25MG/ML SUSP (MCP/AHI) AMOXICILLIN AMOXICILLIN 100ML A 1.79 0.0179 SUSP 300 ML MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0152BQ AMOXICILLIN 25MG/ML SUSP (MCP/AHI) AMOXICILLIN AMOXICILLIN 100ML A 1.79 0.02 SUSPENSION 300 ML MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0153BK AMOXAPEN 500MG CAP (REM/SBI) AMOXICILLIN AMOXICILLIN AMOXAPEN 100X10 A 121.78 0.1218 CAP 56 CAP REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0153C AMOXAPEN 500MG CAP (REM/SBI) AMOXICILLIN AMOXICILLIN AMOXAPEN 100x10 C 115.83 0.12 CAPSULE 0 CAP REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0153CC
41 0153CC AMOXIL 500MG CAP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100'S C 46.65 0.4665 CAP 56 CAP GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0153CC AMOXIL 500MG CAP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100'S C 42.41 0.42 CAPSULE 0 CAP GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0153CS AMOXICILLIN 500MG CAP (FSB/ATB) AMOXICILLIN AMOXICILLIN 1000'S A 72.04 0.07 CAPSULE 28 CAP FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0153CW AMOXAPEN 500MG CAP (REM/SBI) AMOXICILLIN AMOXICILLIN AMOXAPEN 10x10 A 12.64 0.1264 CAP 56 CAP REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 0812 ANTIBACTERIALS ORAL 0 ANTI-INFECTIVE AGENTS
40 0153CW AMOXAPEN 500MG CAP (REM/SBI) AMOXICILLIN AMOXICILLIN AMOXAPEN 10x10 C 10.14 0.10 CAPSULE 0 CAP REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0153DH AMOXICILLIN 500MG CAP (MCP/AHI) AMOXICILLIN AMOXICILLIN 10X10 A 10.03 0.1003 CAP 28 CAP MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 0812 ANTIBACTERIALS Add to Contract ORAL 0 ANTI-INFECTIVE AGENTS
41 0155AG AMOXICILLIN 50MG/ML SUSP (MCP/AHI) AMOXICILLIN AMOXICILLIN 100ML A 2.01 0.0201 SUSP 200 ML MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0155AG AMOXICILLIN 50MG/ML SUSP (MCP/AHI) AMOXICILLIN AMOXICILLIN 100ML A 1.93 0.02 SUSPENSION 200 ML MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0155T
41 0155T AMOXIL 50MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 14.6 0.146 SUSP 200 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS ORAL 0 ANTI-INFECTIVE AGENTS
40 0155T AMOXIL 50MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 13.27 0.13 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS