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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
41 3261Z POVIDONE IODINE 1% SOLN (FSB) (B) POVIDONE IODINE POVIDONE IODINE 1 LITRE B 20.71 0.0207 ML 500 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS
41 3262B POVIDONE IODINE SURGICAL 0.75% SCRUB (RIM) POVIDONE IODINE POVIDONE IODINE SURGICAL 1 GAL B 81.5497 0.0216 ML 500 BOTT RIM RIMA PHARMACEUTICAL LTD PHA PHARMACY SALES CARIBBEAN 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS
40 3262E VIDENE SURGICAL SCRUB 0.75% (ECO/COL) POVIDO POVIDONE IODINE VIDENE SURGICAL SCRUB 500ML B 15.85 0.03 SCRUB 0 ML ECO ECOLAB LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3262H POVIDONE IODINE 0.75% SCRUB (CHC/ATB) POVIDONE IODINE POVIDONE IODINE 500ML B 7.61 0.02 SCRUB 0 ML CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3262J POVIDONE IODINE 0.75% SCRUB (CHC/ATB) DISPENSER POVIDONE IODINE POVIDONE IODINE 500ML B 8.43 0.02 SCRUB 0 ML CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
42 3262K POVIDONE IODINE SCRUB (CHC) POVIDONE IODINE POVIDONE IODINE 500ML B 250.77 0.50 ML 0 CHC CARITAS HEALTHCARE PVT LTD STO BRYDEN STOKES LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-04-01 2028-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-03-05
40 32934 PROCTO-GLYVENOL 40MG | 400MG SUPPOS (GSK/COL) LIDOCAINE | TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 4.73 0.95 SUPPOSITORY 5 SUPP GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 RECTAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 4.97 0.9949 SUPP 5 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 RECTAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 5.22 1.04 SUPP 5 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 RECTAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 32936 PREPARATION H 0.25% SUPPOS (GSK/COL) PHENYLEP PHENYLEPHRINE PREPARATION H 12'S A 14.08 1.17 SUPPOSITORY 12 SUPP GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 32936 PREPARATION H 0.25% SUPPOS (GSK) PH PHENYLEPHRINE PREPARATION H 12'S A 14.79 1.2323 SUPP 12 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3294B PROCTO-GLYVENOL CR (GSK/COL) TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.50 7.50 CREAM 1 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3294B PROCTO-GLYVENOL CR (GSK) TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.61 7.6113 TUBE 1 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 3294B PROCTO-GLYVENOL 40MG|400MG CR (GSK) LIDOCAINE|TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.99 7.99 TUBE 1 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3294S PREPRATION H MULTI-SYMPTOM 0.25% | 1% CR (GSK/COL) PHENYLEPHRINE | PRAMOXINE PHENYLEPHRINE|PRAMOXINE PREPRATION H MULTI-SYMPTOM 26G A 12.69 12.69 CREAM 1 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3294S PREPRATION H MULTI-SYMPTOM 0.25%|1% CR (GSK) PHENYLEPHRINE|P GLYCERINE|PHENYLEPHRINE|PRAMOXINE PREPRATION H MULTI-SYMPTOM 26G A 13.35 13.347 TUBE 1 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3301AD CUTIVATE 0.05% CR (GSK/COL) FLUTICASONE FLUTICASONE CUTIVATE 15G C 11.15 11.15 CREAM 0 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
42 3301AD CUTIVATE 0.05% CR (GSK) FLUTICASONE FLUTICASONE CUTIVATE 15G C 13.48 13.48 TUBE 2 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3301AJ FURASONE 0.1% CR (CAR/COL) MOMETASONE MOMETASONE FURASONE 15G A 5.16 5.16 CREAM 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3301AJ FURASONE 0.1% CR (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.2 6.1978 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL