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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 4181W OCREVUS 300MG INJ (ROC/AHI) OCRELIZUMAB OCRELIZUMAB OCREVUS 10ML C 17,533.1 17,533.1 INJECTION 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 4181W OCREVUS 300MG INJ (ROC) OCRELIZUMAB (BQ) OCRELIZUMAB OCREVUS 10ML BQ 17533.19 17533.189 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 9220 BIOLOGIC RESPONSE MODIFIER 2024-04-01 2026-03-31 IV 0 BIOLOGIC RESPONSE MODIFIER
42 4181W OCREVUS 300MG INJ (ROC) OCRELIZUMAB OCRELIZUMAB OCREVUS 10ML BQ 15,779.87 15,779.87 VIAL 0 VIAL ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 9220 BIOLOGIC RESPONSE MODIFIER 2026-04-01 2028-03-31 IV 0 BIOLOGIC RESPONSE MODIFIER
41 4181Y RIXATHON 10MG/ML INJ (BCH) RITUXIMAB (BQ) RITUXIMAB RIXATHON 2X10ML BQ 768.91 384.4525 VIAL 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
40 42013 PRETERAX 0.625MG | 2.5MG TAB (SER/STO) INDAPAMIDE | PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 36.56 1.22 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 42013 PRETERAX 0.625MG|2.5MG TAB (SER) INDAPAMIDE|PERINDOPRIL (C) INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.2368 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 ACE INHIBITORS
42 42013 PRETERAX 0.625MG|2.5MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
40 42014 PRETERAX 0.625MG | 2.5MG TAB (SER/COL) INDAPAMIDE | PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 36.56 1.22 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 243204 ACE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 42014 PRETERAX 0.625MG|2.5MG TAB (SER) INDAPAMIDE|PERINDOPRIL (C) INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.2368 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 243204 ACE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 ACE INHIBITORS
42 42014 PRETERAX 0.625MG|2.5MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
40 42024 PRETERAX 2.5MG | 10MG TAB (SER/STO) INDAPAMIDE | PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 36.56 1.22 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 42024 PRETERAX 2.5MG|10MG TAB (SER) INDAPAMIDE|PERINDOPRIL (C) INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.2368 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 ACE INHIBITORS
42 42024 PRETERAX 2.5MG|10MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
41 42025 PRETERAX 1.25MG|5MG TAB (SER) INDAPAMIDE|PERINDOPRIL (C) INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.2368 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 ACE INHIBITORS
42 42025 PRETERAX 1.25MG|5MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
42 42026 PRETERAX 1.25MG|5MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
40 42027 PRETERAX 2.5MG | 10MG TAB (SER/COL) INDAPAMIDE | PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 36.56 1.22 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 243204 ACE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 42027 PRETERAX 2.5MG|10MG TAB (SER) INDAPAMIDE|PERINDOPRIL (C) INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.2368 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 243204 ACE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 ACE INHIBITORS
42 42027 PRETERAX 2.5MG|10MG TAB (SER) INDAPAMIDE|PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 37.11 1.24 TAB 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 ACE INHIBITORS
40 42028 PRETERAX 1.5MG | 5MG TAB (SER/COL) INDAPAMIDE | PERINDOPRIL INDAPAMIDE|PERINDOPRIL PRETERAX 30'S C 36.56 1.22 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 243204 ACE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS