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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 3791J ALLEGRA -D 120MG F/60MG P TAB (SFA/COL) FEXOF (C) FEXOFENADINE|PSEUDOEPHEDRINE ALLEGRA -D 10'S C 14.54 1.454 TABLET IMMED SFA SANOFI AVENTIS COL COLLINS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-10 2024-03-31 Price Change Oral 0 SECOND GENERATION ANTIHISTAMINES 2022-12-09
40 3791K ZYRTEC-D 5MG C/120MG P CAP (GSK/COL) CETIRIZI CETIRIZINE|PSEUDOEPHEDRINE ZYRTEC-D 10'S C 16.31 1.63 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 3791K ZYRTEC-D 5MG|120MG TAB (GSK) CETIRIZINE|PSEUDOEPHEDRINE (C) CETIRIZINE|PSEUDOEPHEDRINE ZYRTEC-D 10'S C 16.31 1.631 TAB 0 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2025-02-18 ORAL 0 SECOND GENERATION ANTIHISTAMINES 2025-01-07
40 3791M HISTAL DC 4MG/60MG TAB (CAR/COL) CHLORPHENIR CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 150'S C 48.93 0.33 TABLET 0 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0404 FIRST GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 3791W HISTAL DC 2MG|30MG TAB (CAR) CHLORPHENIRAMINE|PSEUDOEPHEDRIN (C) CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 150'S C 48.93 0.3262 TAB 0 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
42 3791W HISTAL DC 2MG|30MG TAB (CAR) CHLORPHENIRAMINE|PSEUDOEPHEDRIN CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 150'S C 48.93 0.33 TAB 0 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 2028-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 3792E HISTAL DC 0.4MG/ML | 6MG/ML SYR (CAR/COL) CHLORPHENIRAMINE | PSEUDOEPHEDRINE CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 2 LITRES C 61.43 0.03 SYRUP 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0404 FIRST GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 3792E HISTAL DC 0.4MG/ML|6MG/ML SYR (CAR) CHLORPHENIRAMINE|PSEUDOE (C) CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 2 LITRES C 73.39 0.0367 ML 0 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0404 FIRST GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 FIRST GENERATION ANTIHISTAMINES
42 3792E HISTAL DC 0.4MG/ML|6MG/ML SYR (CAR) CHLORPHENIRAMINE|PSEUDOE CHLORPHENIRAMINE|PSEUDOEPHEDRINE HISTAL DC 2 LITRES C 73.39 0.04 ML 0 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 0404 FIRST GENERATION ANTIHISTAMINES 2026-04-01 2028-03-31 ORAL 0 FIRST GENERATION ANTIHISTAMINES
40 38513 BUSCOPAN PLUS 10MG | 500MG TAB (SFA/COL) HYOSCI HYOSCINE BUTYLBROMIDE|PARACETAMOL BUSCOPAN PLUS 20'S C 10.19 0.51 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 120808 ANTIMUSCARINICS/ANTISPASMODICS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 38721 NADOLOL 80MG TAB (ZYD) NADOLOL NADOLOL 100'S C 115.6375 1.1564 TAB 60 BOTT ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 0 BETA ADRENERGIC BLOCKING AGENTS
41 39111 MINOXIDIL 2.5MG TAB (WAT) MINOXIDIL MINOXIDIL 100'S A 14.6 0.146 TAB 120 BOTT WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 ORAL 6 DIRECT VASODILATOR
40 3911C MINOXIDIL 2.5MG TAB (KWA/ATB) MINOXIDIL MINOXIDIL 10X10 A 38.06 0.38 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2022-04-01 2022-04-02 Oral 6 CARDIOVASCULAR DRUGS
40 3911C MINOXIDIL 2.5MG TAB (KWA/ATB) MINOXIDIL MINOXIDIL 10X10 A 56.79 0.57 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2022-04-03 2024-03-31 Price Change Oral 6 CARDIOVASCULAR DRUGS 2022-06-14
42 3911F MINOXYQURE 2.5MG TAB (JLP) MINOXIDIL MINOXIDIL MINOXYQURE 10X10 A 11.96 0.12 TAB 120 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 240820 DIRECT VASODILATOR 2026-04-01 2028-03-31 ORAL 6 DIRECT VASODILATOR
41 39127 MINOXIDIL 10MG TAB (WAT) MINOXIDIL MINOXIDIL 100'S A 21.15 0.2115 TAB 120 BOX WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 ORAL 6 DIRECT VASODILATOR
40 3912F MINOXIDIL 10MG TAB (KWA/ATB) MINOXIDIL MINOXIDIL 10X10 A 48.93 0.49 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2022-04-01 2022-04-02 Oral 6 CARDIOVASCULAR DRUGS
40 3912F MINOXIDIL 10MG TAB (KWA/ATB) MINOXIDIL MINOXIDIL 10X10 A 93.13 0.93 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2022-04-03 2024-03-31 Price Change Oral 6 CARDIOVASCULAR DRUGS 2022-06-14
40 39216 PLAVIX 75MG TAB (SFA/COL) CLOPIDOGREL CLOPIDOGREL PLAVIX 28'S C 81.55 2.91 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 201218 PLATELET AGGREGATION INHIBITORS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 39216 PLAVIX 75MG TAB (SFA) CLOPIDOGREL (C) CLOPIDOGREL PLAVIX 28'S C 81.55 2.9125 TAB 30 BOX SFA SANOFI AVENTIS COL COLLINS LTD 201218 PLATELET AGGREGATION INHIBITORS 2024-04-01 2026-03-31 ORAL 6 PLATELET AGGREGATION INHIBITORS