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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 35931 LAMICTAL 100MG TAB (GSK) LAMOTRIGINE LAMOTRIGINE LAMICTAL 30'S C 103.30 3.44 TAB 60 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 3593G APO-LAMOTRIGINE 100MG TAB (APO/COL) LAMOTRIGINE APO-LAMOTRIGINE 100'S B 25.93 0.26 TABLET 0 TAB APO APOTEX INC. COL COLLINS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 3593M APO-LAMOTRIGINE 100MG TAB (APO) LAM (B) LAMOTRIGINE APO-LAMOTRIGINE 100'S B 26.45 0.2645 TAB 60 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 3593N LEMOGIN 100MG DISP TAB (JLP) LAMOTRIGINE LAMOTRIGINE LEMOGIN 20X10 B 25.82 0.13 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 ANTICONVULSANTS MISCELLANEOUS
40 3621B APO-LEVOCARB 10MG | 100MG TAB (APO/COL) CARBIDOPA|LEVODOPA APO-LEVOCARB 100'S A 17.26 0.17 TABLET 240 TAB APO APOTEX INC. COL COLLINS LTD 283616 DOPAMINE PRECURSORS 2022-04-01 2024-03-31 Add to Contract as Cat A Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-04-01
42 3621B APO-LEVOCARB 10MG|100MG TAB (APO) CARBIDOPA|LEVODOPA APO-LEVOCARB 100'S A 22.53 0.23 TAB 240 BOTT APO APOTEX INC. COL AVENTA BARBADOS 283616 DOPAMINE PRECURSORS 2026-04-01 2028-03-31 ORAL 6 DOPAMINE PRECURSORS
41 3621G APO-LEVOCARB 10MG|100MG TAB (APO) CARBIDOPA|LEVODOPA APO-CARBIDOPA|LEVODOPA 100'S A 22.53 0.2253 TAB 240 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 283616 DOPAMINE PRECURSORS 2024-04-01 2026-03-31 ORAL 6 DOPAMINE PRECURSORS
41 36222 SINEMET 25MG|250MG TAB (MSD) CARBIDOPA|L (C) CARBIDOPA|LEVODOPA SINEMET 100'S C 79.97 0.7997 TAB 240 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 283616 DOPAMINE PRECURSORS 2024-04-01 2026-03-31 ORAL 6 DOPAMINE PRECURSORS
40 36223 PROLOPA 50MG | 200MG TAB (ROC/AHI) BENSERAZIDE | BENSERAZIDE|LEVODOPA PROLOPA 30'S A 40.77 1.36 TABLET 240 TAB ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 283616 DOPAMINE PRECURSORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 36223 PROLOPA 50MG|200MG TAB (ROC) BENSERAZIDE|LEVODOPA BENSERAZIDE|LEVODOPA PROLOPA 30'S A 30.15 1.005 TAB 240 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 283616 DOPAMINE PRECURSORS 2024-09-27 2026-03-31 ORAL 6 DOPAMINE PRECURSORS 2024-09-27
40 36227 APO-LEVOCARB 25MG | 250MG TAB (APO/COL) CARBIDOPA|LEVODOPA APO-LEVOCARB 100'S A 27.18 0.27 TABLET 240 TAB APO APOTEX INC. COL COLLINS LTD 283616 DOPAMINE PRECURSORS 2022-04-01 2024-03-31 Add to Contract as Cat A Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-04-01
41 3622K CREDANIL 25MG|250MG TAB (REM) CARBIDOPA| CARBIDOPA|LEVODOPA CREDANIL 50'S A 11.34 0.2267 TAB 240 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 283616 DOPAMINE PRECURSORS 2024-04-01 2026-03-31 ORAL 6 DOPAMINE PRECURSORS
42 3622K CREDANIL 25MG|250MG TAB (REM) CARBIDOPA|LEVODOPA CARBIDOPA|LEVODOPA CREDANIL 50'S A 11.42 0.23 TAB 240 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 283616 DOPAMINE PRECURSORS 2026-04-01 2028-03-31 ORAL 6 DOPAMINE PRECURSORS
41 3622R APO-LEVOCARB 25MG|250MG TAB (APO) CARBIDOPA|LEVODOPA APO-CARBIDOPA|LEVODOPA 100'S A 25.61 0.2561 TAB 240 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 283616 DOPAMINE PRECURSORS 2024-04-01 2026-03-31 ORAL 6 DOPAMINE PRECURSORS
42 3622V BENKINSON 50MG|200MG CAP (INC) BENSERAZIDE|LEVODOPA BENSERAZIDE|LEVODOPA BENKINSON 20'S A 15.71 0.79 CAP 240 BLIS INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 283616 DOPAMINE PRECURSORS 2026-04-01 2028-03-31 ORAL 6 DOPAMINE PRECURSORS
40 3631AX ACCORD METOCLOPRAMIDE 10MG TAB (INP/AAL) METO METOCLOPRAMIDE ACCORD METOCLOPRAMIDE 30'S A 1.96 0.07 TABLET 90 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
40 3631BB METOCLOPRAMIDE 10MG TAB (FSB/ATB) METOCLOPRAMIDE METOCLOPRAMIDE 500'S A 21.72 0.04 TABLET 90 TAB FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
41 3631BB METOCLOPRAMIDE 10MG TAB (FSB) METOCLOPRAMIDE METOCLOPRAMIDE 500'S A 21.86 0.0437 TAB 90 BOX FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 5632 GI PROKINETIC AGENTS 2024-04-01 2026-03-31 ORAL 6 GI PROKINETIC AGENTS
42 3631BC MPRANIM 10MG TAB (ANC) METOCLOPRAMIDE METOCLOPRAMIDE MPRANIM 500'S A 8.70 0.02 TAB 90 BOTT ANC AEONIM HEALTHCARE SBI MASSY DISTRIBUTION (BDOS) LTD 5632 GI PROKINETIC AGENTS 2026-04-01 2028-03-31 ORAL 6 GI PROKINETIC AGENTS
40 3633AG METOCLOPRAMIDE 5MG/ML IV/IM INJ (MON/PHA) METOCLOPRAMIDE METOCLOPRAMIDE 10X2ML B 6.01 0.60 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 IV/IM 0 GASTROINTESTINAL DRUGS