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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 3701BA ACCU-CHEK INSTANT GLUC (PRI/STO) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE ACCU-CHEK INSTANT 50'S A 42.30 42.30 GLUCOSE STRI 1 PACK PRI PRODUCTOS ROCHE INTERAMERICANA SA STO BRYDEN STOKES LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701BA ACCU-CHEK INSTANT GLUC (PRI) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE ACCU-CHEK INSTANT 50'S A 42.3 42.2971 PACK 1 BOX PRI PRODUCTOS ROCHE INTERAMERICANA SA STO BRYDEN STOKES LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701BA ACCU-CHEK INSTANT GLUC (PRI) DIAGNOSTIC DIAGNOSTIC BLOOD GLUCOSE ACCU-CHEK INSTANT 50'S A 42.30 42.30 PACK 1 BOX PRI PRODUCTOS ROCHE INTERAMERICANA SA STO BRYDEN STOKES LTD B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701BE SELECT FLEX PLUS GLUC (JOH/AAL) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.23 39.2254 PACK 1 BOX JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 40.39 40.39 PACK 1 BOX JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701U SKY ERA GLUC (TTC/COL) DIAGNOSTIC BLOOD GLUC DIAGNOSTIC BLOOD GLUCOSE SKY ERA 50'S A 38.00 38.00 GLUCOSE STRI 1 PACK TTC TAIDOC TECHNOLOGY CORPORATION COL COLLINS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701U SKY ERA GLUC (TTC) DIAGNOSTIC BLOOD GLU DIAGNOSTIC BLOOD GLUCOSE SKY ERA 50'S A 38 38.0022 PACK 1 BOX TTC TAIDOC TECHNOLOGY CORPORATION COL COLLINS LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701U SKY ERA GLUC (TTC) DIAGNOSTIC BLOOD GLU DIAGNOSTIC BLOOD GLUCOSE SKY ERA 50'S A 38.00 38.00 PACK 1 BOX TTC TAIDOC TECHNOLOGY CORPORATION COL AVENTA BARBADOS B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701V LIFESCAN ONE TOUCH ULTRA GLUC (JOH/AAL) DIAG DIAGNOSTIC BLOOD GLUCOSE LIFESCAN ONE TOUCH ULTRA 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 3721B DT ADULT (SII/COL) DIPHTHERIA/TETANUS DIPHTHERIA TOXOID|TETANUS TOXOID DT ADULT 1 DS VIAL B 13.32 13.32 INJECTION 0 VIAL SII SERUM INSTITUTE OF INDIA PRIVATE LTD COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IM 0 SERUMS, TOXOIDS AND VACCINES
41 3721B DT ADULT ≤2IU|≥40IU INJ (SII) DIPHTHERIA TOXOID|TETANUS TOXO (B) DIPHTHERIA TOXOID|TETANUS TOXOID DT ADULT 1 DS VIAL B 13.32 13.3198 VIAL 0 VIAL SII SERUM INSTITUTE OF INDIA PRIVATE LTD COL COLLINS LTD 8012 VACCINES 2024-04-01 2026-03-31 IM 0 VACCINES
40 37314 ADACEL TDaP INJ (AVP/COL) DIP/TET/PERT ACELL ACELLULAR PERTUSSIS|DIPHTHERIA|TETANUS TOXOID ADACEL TDaP 1 DOSE B 41.59 41.59 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 37314 ADACEL TDaP INJ (AVP) DIP/TET/PERT ACEL (B) ACELLULAR PERTUSSIS|DIPHTHERIA|TETANUS TOXOID ADACEL TDaP 1 DOSE B 39.14 39.1439 VIAL 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2024-04-01 2024-10-21 IV 0 VACCINES 2024-09-09
40 37318 BOOSTRIX PFS 8MCG | 2.5LF | 5LF INJ (GSK/COL) ACELLULAR PERTUSSIS | DIPHTHERIA T More ... ACELLULAR PERTUSSIS|DIPHTHERIA TOXOID|TETANUS TOXOID BOOSTRIX PFS 1 DOSE B 55.45 55.45 INJECTION 0 VIAL GSK GLAXOSMITHKLINE COL COLLINS LTD 8008 TOXOIDS 2022-04-01 2024-03-31 IV 0 SERUMS, TOXOIDS AND VACCINES
41 37318 BOOSTRIX PFS 8MCG|2.5LF|5LF INJ (GSK) ACELLULAR PERTUSSIS|DI (B) ACELLULAR PERTUSSIS|DIPHTHERIA TOXOID|TETANUS TOXOID BOOSTRIX PFS 1 DOSE B 58.77 58.7702 VIAL 0 VIAL GSK GLAXOSMITHKLINE COL COLLINS LTD 8012 VACCINES 2024-04-01 2026-03-31 IV 0 VACCINES
42 37318 BOOSTRIX PFS 8MCG|2.5LF|5LF INJ (GSK) ACELLULAR PERTUSSIS|DI ACELLULAR PERTUSSIS|DIPHTHERIA TOXOID|TETANUS TOXOID BOOSTRIX PFS 1 DOSE B 59.01 59.01 VIAL 0 VIAL GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8012 VACCINES 2026-04-01 2028-03-31 IV 0 VACCINES
40 37419 OSMITROL 10% INJ (BAX/STO) MANNITOL MANNITOL OSMITROL 500ML B 12.75 12.75 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 402812 OSMOTIC DIURETICS 2022-04-01 2024-03-31 Add to Contract as Cat B IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-04-01
41 37419 OSMITROL 10% INJ (BAX) MANNITOL MANNITOL OSMITROL 500ML BQ 14.57 14.5702 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 402812 OSMOTIC DIURETICS 2024-04-01 2026-03-31 IV 0 OSMOTIC DIURETICS
40 3742E OSMITROL (2D5632Q) 20% INJ (BAX/STO) MANNITOL MANNITOL OSMITROL (2D5632Q) 250ML BQ 13.86 13.86 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 402812 OSMOTIC DIURETICS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE