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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 375E1 DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN DIALYSIS SOLN DIANEAL (5B9876) 6X2L BQ 208.41 34.74 BAG 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2026-04-01 2028-03-31 IV 0 IRRIGATING SOLUTIONS 2026-01-28
42 375E7 DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN DIALYSIS SOLN DIANEAL(5B9876) 6X2 LITRE BQ 208.41 34.74 BAG 0 BOX BAX BAXTER EXPORT CORP. AHI ARMSTRONG HEALTHCARE INC 4036 IRRIGATING SOLUTIONS 2026-04-01 2028-03-31 IV 0 IRRIGATING SOLUTIONS 2026-01-29
40 375F1 DIANEAL (5B9896) 4.25% INJ (BAX/STO) DIALYSIS SOLN DIALYSIS SOLN DIANEAL (5B9896) 6X2L B 110.91 18.49 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 375F1 DIANEAL (5B9896) 4.25% INJ (BAX) DIALYSIS SOLN DIALYSIS SOLN DIANEAL (5B9896) 6X2L B 133.2 22.2 BAG 100 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2024-04-01 2026-03-31 IV 0 IRRIGATING SOLUTIONS
42 375F1 DIANEAL (5B9896) 4.25% SOLN (BAX) DIALYSIS SOLN DIALYSIS SOLN DIANEAL (5B9896) 6X2L BQ 208.41 34.74 BAG 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2026-04-01 2028-03-31 IV 0 IRRIGATING SOLUTIONS 2026-01-28
42 375F6 DIANEAL (5B9896) 4.25% SOLN (BAX) DIALYSIS SOLN DIALYSIS SOLN DIANEAL(5B9896) 6X2 LITRE BQ 208.41 34.74 BAG 0 BOX BAX BAXTER EXPORT CORP. AHI ARMSTRONG HEALTHCARE INC 4036 IRRIGATING SOLUTIONS 2026-04-01 2028-03-31 IV 0 IRRIGATING SOLUTIONS 2026-01-29
40 37617 TYPHIM V1 (AVP/COL) TYPHOID SALMONELLA TYPHI TYPHIM V1 1 DS SYRNG B 31.80 31.80 INJECTION 0 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2022-04-01 2024-03-31 IM 0 SERUMS, TOXOIDS AND VACCINES
41 37617 TYPHIM V1 (AVP) TYPHOID SALMONELLA TYPHI TYPHIM V1 1 DS VIAL B 33.41 33.4082 VIAL 1 VIAL AVP SANOFI PASTEUR COL COLLINS LTD 8012 VACCINES 2024-04-01 2024-10-21 IM 0 VACCINES 2024-09-09
40 37834 DEXTROSE | SODIUM CHLORIDE 5% | 0.2% INJ (BAX/STO) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 1 LITRE B 4.62 4.62 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 37834 DEXTROSE|SODIUM CHLORIDE 5%|0.2% INJ (BAX) (B) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 1 LITRE B 7.83 7.8288 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 37834 DEXTROSE|SODIUM CHLORIDE 5%|0.2% INJ (BAX) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 1 LITRE B 8.51 8.51 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 37842 DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (BAX/STO) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 250ML B 3.07 3.07 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 37845 DEXTROSE|SODIUM CHLORIDE 5%|0.9% INJ (CSC) (B) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 250ML B 2.15 2.1475 BAG 100 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2024-04-01 2026-03-31 INJ 0 CALORIC AGENTS
40 3785D DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (BAX/STO) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 3.34 3.34 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 3785D DEXTROSE|SODIUM CHLORIDE 5%|0.9% INJ (BAX) (B) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 5.03 5.0289 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 3785D DEXTROSE|SODIUM CHLORIDE 5%|0.9% INJ (BAX) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 6.23 6.22 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 3785G DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 2.85 2.85 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 3785G DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 3.79 3.79 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 3785G DEXTROSE|SODIUM CHLORIDE 5%|0.9% INJ (CSC) (B) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 500ML B 2.45 2.4465 BAG 100 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
40 37862 DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (BAX/STO) DEXTROSE|SODIUM CHLORIDE DEXTROSE|SODIUM CHLORIDE 1 LITRE B 3.18 3.18 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE