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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 39634 EPILIM CHRONO 199.8MG | 87MG TAB (SFA/COL) SODI SODIUM VALPROATE|VALPROIC ACID EPILIM CHRONO 30'S A 14.95 0.50 TABLET 150 TAB SFA SANOFI AVENTIS COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 39635 VALEX 199.8MG|87MG CR TAB(INC) SODIUM VALPROATE|VALPROIC AC VALPROATE|VALPROIC AC VALEX 199.8MG|87MG CR TAB 30 A $12.18 0.406 TABLET 150 TAB INC AHI ARMSTRONG HEALTH CARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 0000-00-00 0000-00-00 ORAL 6 CENTRAL NERVOUS SYSTEM DRUGS 0000-00-00
41 39635 VALEX 199.8MG|87MG CR TAB (INC) SODIUM VALPROATE|VALPROIC AC SODIUM VALPROATE|VALPROIC ACID VALEX 3X10 A 13.16 0.4387 TABCR 90 BOX INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC A 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS 2023-10-03
42 39639 LEEPORATE CHRONO 199.8MG|87MG CR TAB (JLP) SODIUM VALPROATE| SODIUM VALPROATE|VALPROIC ACID LEEPORATE CHRONO 10X10 A 14.14 0.14 TAB 150 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 3963A VALSONIM 199.8MG|87MG CR TAB (ANC) SODIUM VALPROATE|VALPROIC SODIUM VALPROATE|VALPROIC ACID VALSONIM 100'S A 10.52 0.11 TAB 150 ANC AEONIM HEALTHCARE SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS 2026-01-30
41 39648 SODIUM VALPROATE 100MG/ML INJ (DIL) (B) SODIUM VALPROATE SODIUM VALPROATE 10X5ML B 142.66 14.2658 VIAL 0 BOX DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 IV 0 ANTICONVULSANTS MISCELLANEOUS
40 39654 DEPAKOTE ER 500MG TAB (ABB/PHA) VALPROIC ACID VALPROIC ACID DEPAKOTE ER 100'S A 71.36 0.71 TABLET 120 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 39654 DEPAKOTE ER 500MG TAB (ABB/PHA) VALPROIC ACID VALPROIC ACID DEPAKOTE ER 100'S A 71.36 0.7136 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 6 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 39659 DEPAKOTE 500MG TAB (ABB/PHA) VALPROIC ACID VALPROIC ACID DEPAKOTE 30'S A 45.67 1.52 TABLET 120 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 39659 DEPAKOTE 500MG TAB (ABB/PHA) VALPROIC ACID VALPROIC ACID DEPAKOTE 30'S A 45.67 1.5223 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 6 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 3965A EPILIM CHRONO 333MG | 145M TAB (SFA/COL) SODIUM VALPROATE | VALPROIC ACID SODIUM VALPROATE|VALPROIC ACID EPILIM CHRONO 30'S A 19.54 0.65 TABLET 150 TAB SFA SANOFI AVENTIS COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 3965A EPILIM CHRONO 333MG|145MG CR TAB (SFA) SODIUM VALPROATE|VALP SODIUM VALPROATE|VALPROIC ACID EPILIM CHRONO 30'S A 19.54 0.6515 TABCR 120 BOX SFA SANOFI AVENTIS COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 3965C DEPAKOTE 500MG TAB (ABB) SODIUM VALPROIC SODIUM VALPROIC DEPAKOTE 30 A $45.65 1.521 TABLET 90 TAB ABB ABBOTT LABORATORIES SBI MASSY DISTRIBUTION B 281292 ANTICONVULSANTS MISCELLANEOUS 0000-00-00 0000-00-00 CHANGE OF DISTRIBUTOR ORAL 6 CENTRAL NERVOUS SYSTEM DRUGS 0000-00-00
41 3965C DEPAKOTE 500MG TAB (ABB) VALPROIC ACID VALPROIC ACID DEPAKOTE 30'S A 47.84 1.5948 TAB 120 BOTT ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 3965C DEPAKOTE 500MG TAB (ABB) VALPROIC ACID VALPROIC ACID DEPAKOTE 30'S A 43.49 1.45 TAB 120 BOTT ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
41 3965D DEPAKOTE 500MG ER TAB (ABB) VALPROIC ACID VALPROIC ACID DEPAKOTE ER 30'S A 26.91 0.897 TABER 150 BOTT ABB ABBOTT SBI MASSY DISTRIBUTION (BDOS) LTD A 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 3965G VALSONIM 500MG TAB (ANC) VALPROIC ACID SODIUM VALPROATE|VALPROIC ACID VALSONIM 100'S A 19.03 0.19 TAB 120 BLIS ANC AEONIM HEALTHCARE SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS 2026-02-05
42 3965L LEEPORATE CHRONO 333MG|145MG CR TAB (JLP) SODIUM VALPROATE|V SODIUM VALPROATE|VALPROIC ACID LEEPORATE CHRONO 10X10 A 15.22 0.15 TAB 120 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 4021C AZITHROMYCIN 500MG INJ (DIL/AHI) AZITHROMYCIN AZITHROMYCIN 10X500MG BQ 403.83 40.38 INJECTION 0 VIAL DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 08121292 OTHER MACROLIDES 2022-04-01 2022-09-30 IV 0 ANTI-INFECTIVE AGENTS 2022-03-29
40 4021E ERYTHROMYCIN 500MG INJ (CIR/AHI) ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN 500MG VIAL BQ 28.92 28.92 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS