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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 02223 CLOXACILLIN 500MG CAP (REM/SBI) CLOXACILLIN CLOXACILLIN 10x10 A 16.39 0.16 CAPSULE 28 CAP REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS 2021-12-03
41 02238 CLOXACILLIN 25MG/ML SUSP (KWA) CLOXACILLIN CLOXACILLIN 60ML A 25.8241 0.4304 ML 300 BOTT KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 081216 PENICILLINS 2024-04-01 2026-03-31 ORAL 0 PENICILLINS
40 0225H LACLOXA 500MG INJ (LDP/AHI) CLOXACILLIN CLOXACILLIN LACLOXA 500MG VIAL B 15.41 15.41 INJECTION 0 VIAL LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS 2022-04-01 2022-09-30 IV 6 ANTI-INFECTIVE AGENTS 2022-03-29
40 0225K CLOXACILLIN 500MG INJ (MON/PHA) CLOXACILLIN CLOXACILLIN 500MG VIAL B 1.58 1.58 INJECTION 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 081216 PENICILLINS 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS
41 0225L CLOXACILLIN 500MG INJ (JOL) (B) CLOXACILLIN CLOXACILLIN 500MG VIAL B 6.31 6.3065 VIAL 56 VIAL JOL JOLLY PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 081216 PENICILLINS 2024-04-01 2026-03-31 IV 6 PENICILLINS
41 0225M LACLOXA 500MG INJ (LDP) CLOXACILLIN (B) CLOXACILLIN LACLOXA 10X5ML B 62.79 6.2793 VIAL 56 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 081216 PENICILLINS 2024-04-01 2026-03-31 IV 6 PENICILLINS
40 02316 DULERA 5MCG | 100MCG INHR (MSD/STO) FORMOTEROL | MOMETASONE FORMOTEROL|MOMETASONE DULERA 120 DOSES B 56.68 56.68 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02316 DULERA 5MCG|100MCG INHR (MSD) FORMOTEROL|MOMETASONE (C) FORMOTEROL|MOMETASONE DULERA 120 DOSES C 58.39 58.3896 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 0231B SYMBICORT RAPIHALER 80MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (R) BUDESONIDE|FORMOTEROL (R) SYMBICORT RAPIHALER 120 DOSES A 35.23 35.23 INHALER 1 INHR AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 0231B SYMBICORT RAPIHALER 80MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMO BUDESONIDE|FORMOTEROL (R) SYMBICORT RAPIHALER 120 DOSES A 35.23 35.2295 INHR 1 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 0231C SYMBICORT TURBU 80MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL BUDESONIDE|FORMOTEROL SYMBICORT TURBU 60 DOSES A 24.27 24.27 INHALER 1 INHR AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 0231C SYMBICORT TURBU 80MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMOTERO BUDESONIDE|FORMOTEROL SYMBICORT TURBU 60 DOSES A 24.27 24.2746 INHR 1 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 02326 DULERA 200MCG/5MCG INHR (MSD/STO) MOMETASONE/ FORMOTEROL|MOMETASONE DULERA 120 DOSES B 59.26 59.26 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02326 DULERA 200MCG/5MCG INHR (MSD) MOMETASONE (B) FORMOTEROL|MOMETASONE DULERA 120 DOSES B 61.03 61.0264 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 0232D SYMBICORT TURBU 160MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (60) BUDESONIDE|FORMOTEROL (60) SYMBICORT TURBU 60 DOSES A 32.62 32.62 INHALER 1 INHR AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 0232D SYMBICORT TURBU 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMOTER BUDESONIDE|FORMOTEROL (60) SYMBICORT TURBU 60 DOSES A 32.62 32.6199 INHR 1 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 0232E SYMBICORT RAPIHALER 160MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (120 More ... BUDESONIDE|FORMOTEROL (120 R) SYMBICORT RAPIHALER 120 DOSES A 37.68 37.68 INHALER 1 INHR AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 0232E SYMBICORT RAPIHALER 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORM BUDESONIDE|FORMOTEROL (120 R) SYMBICORT RAPIHALER 120 DOSES A 37.68 37.676 INHR 1 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 0232F SYMBICORT TURBU 160MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (120) BUDESONIDE|FORMOTEROL (120) SYMBICORT TURBU 120 DOSES A 44.31 44.31 INHALER 1 INHR AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 0232F SYMBICORT TURBU 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMOTER BUDESONIDE|FORMOTEROL (120) SYMBICORT TURBU 120 DOSES A 44.31 44.3087 INHR 1 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS