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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 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) NALOXONE NALOXONE 5X1ML BQ 13.54 2.71 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) NALOXONE NALOXONE 5X1ML BQ 13.54 2.708 INJECTION MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2023-03-20 2024-03-31 Delete from contract IV OPIATE ANTAGONISTS 2023-02-14
42 3681T NALOXONE 0.4MG/ML INJ (MON) NALOXONE NALOXONE 5X1ML B 16.01 3.20 AMPG 0 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2026-04-01 2028-03-31 IV 0 OPIATE ANTAGONISTS
40 3681V NALOXONE 0.4MG/ML AMP (RTM/PHA) NALOXONE NALOXONE 10'S 57.86 5.786 AMPOULE GLAS VIAL RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2023-03-20 2024-03-31 Price Change IV/IM OPIATE ANTAGONISTS 2023-02-14
41 3681W NALOXONE 0.4MG/ML INJ (OMG) (B) NALOXONE NALOXONE 10X1ML B 47.35 4.7353 VIAL 0 BOX OMG OMEGA COL COLLINS LTD 2810 OPIATE ANTAGONISTS 2024-04-01 2026-03-31 IV/IM/SC 0 OPIATE ANTAGONISTS
42 3681W NALOXONE 0.4MG/ML INJ (OMG) NALOXONE NALOXONE 10X1ML B 52.19 5.22 VIAL 0 VIAL OMG OMEGA COL AVENTA BARBADOS 2810 OPIATE ANTAGONISTS 2026-04-01 2028-03-31 IV/IM/SC 0 OPIATE ANTAGONISTS
40 37019 FREESTYLE OPTIUM GLUC (ABD/PHA) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 42.11 42.11 GLUCOSE STRI 1 PACK ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV PHA PHARMACY SALES CARIBBEAN B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 37019 FREESTYLE OPTIUM GLUC (ABD/PHA) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 40.01 40.01 GLUCOSE STRI ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV PHA PHARMACY SALES CARIBBEAN B 3626 DIABETES MELLITUS 2023-02-20 2024-03-31 Price Change 6 DIABETES MELLITUS 2023-01-09
41 37019 FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 42.13 42.134 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV PHA PHARMACY SALES CARIBBEAN B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 37019 FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 42.13 42.13 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV PHA PHARMACY SALES CARIBBEAN B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS 2025-10-08
40 3701AP BAYER NEXT EZ GLUC (BYC/AHI) DIAGNOSTIC BLOO DIAGNOSTIC BLOOD GLUCOSE BAYER NEXT EZ 50'S A 40.23 40.23 GLUCOSE STRI 1 PACK BYC BAYER S.A AHI ARMSTRONG HEALTHCARE INC B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701AP CONTOUR NEXT GLUC (BYC) DIAGNOSTIC BLOOD GLUCOSE DIAGNOSTIC BLOOD GLUCOSE CONTOUR NEXT 50'S A 40.23 40.2312 PACK 1 BOX BYC Siemens Medcal Solutions AHI ARMSTRONG HEALTHCARE INC B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701AP CONTOUR NEXT GLUC (BYC) DIAGNOSTIC BLOOD GLUCOSE DIAGNOSTIC BLOOD GLUCOSE CONTOUR NEXT 50'S A 41.64 41.64 PACK 1 BOX BYC ASCENSIA DIABETES CARE AHI ARMSTRONG HEALTHCARE INC B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701AW TRUE METRIX (HOM/ALI) DIAGNOSTIC BLOOD GLUC DIAGNOSTIC BLOOD GLUCOSE TRUE METRIX 50'S A 30.04 30.04 GLUCOSE STRI 1 PACK HOM NIPRO DIAGNOSTICS ALI ALL HEALTH INC B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 3701AX FREESTYLE NEO H GLUC (ABD/SBI) DIAGNOSTIC BL DIAGNOSTIC BLOOD GLUCOSE FREESTYLE NEO H 50'S BQ 40.10 40.10 GLUCOSE STRI 0 PACK ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 0 DIAGNOSTIC AGENTS
41 3701AX FREESTYLE NEO H GLUC (ABD) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE FREESTYLE NEO H 50'S BQ 54.5 54.5 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701AX FREESTYLE NEO H GLUC (ABD) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE FREESTYLE NEO H 50'S B 40.10 40.10 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701AZ FREESTYLE OPTIUM GLUC (ABD/SBI) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 40.10 40.10 GLUCOSE STRI 1 PACK ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701AZ FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 42.13 42.13 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS 2024-01-02
42 3701AZ FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE FREESTYLE OPTIUM 50'S A 40.10 40.10 PACK 1 BOX ABD ABBOTT LABORATORIES, DIAGNOSTIC DIV SBI MASSY DISTRIBUTION (BDOS) LTD B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS