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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 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 30.09 1.07 TAB 30 BLIS KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
41 4463G RIVASTIGMINE 4.5MG CAP (KWA) (C) RIVASTIGMINE RIVASTIGMINE 60'S C 99.82 1.6636 CAP 30 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 0 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4463J RIVASTIGMINE 4.5MG TAB (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 96.69 1.61 TABLET 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) DONEPEZIL DONEPEZIL 90'S A 25.82 0.29 TABLET 30 TAB JUB JUBILANT LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 deleted from Contract Oral 6 AUTONOMIC DRUGS
40 4463N DONEPEZIL 5MG TAB (CIP/AHI) DONEPEZIL DONEPEZIL 4X7'S A 8.05 0.2875 TABLET IMMED 30 CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-11-29 2024-03-31 Add to Contract as Cat A oral 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-11-29
42 4463W DONEMAX 5MG TAB (JLP) DONEPEZIL DONEPEZIL DONEMAX 10X10 A 21.47 0.21 TAB 30 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 44642 ARICEPT 10MG TAB (PFI/STO) DONEPEZIL DONEPEZIL ARICEPT 28'S C 144.45 5.16 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 44642 ARICEPT 10MG TAB (PFI) DONEPEZIL (C) DONEPEZIL ARICEPT 28'S C 128.55 4.5911 TAB 30 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 44642 ARICEPT 10MG TAB (PFI) DONEPEZIL DONEPEZIL ARICEPT 28'S C 128.55 4.59 TAB 30 BLIS PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4464A APO-DONEPEZIL 10MG TAB (APO/COL) DONEPEZIL DONEPEZIL APO-DONEPEZIL 100'S A 95.14 0.95 TABLET 30 TAB APO APOTEX INC. COL COLLINS LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 6 AUTONOMIC DRUGS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S C 47.57 1.70 TABLET 0 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 Oral 0 AUTONOMIC DRUGS
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL DONEPEZIL YASNAL Q DISP 28'S A 47.57 1.70 TABLET 30 TAB KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-06-17 2022-09-30 Oral 6 AUTONOMIC DRUGS 2022-06-17
41 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL (C) DONEPEZIL YASNAL Q 28'S C 47.57 1.699 TABDISP 0 BOX KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL DONEPEZIL YASNAL Q 28'S C 47.57 1.70 TABDISP 0 BLIS KRK KRKA AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 0 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4464K RIVASTIGMINE 6MG CAP (DRL/AHI) RIVASTIGMINE RIVASTIGMINE 60'S C 107.32 1.79 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 4464P PMS-DONEPEZIL 10MG TAB (PMS) DONEPEZIL PMS-DONEPEZIL 100'S A 53.01 0.5301 TAB 30 BOTT PMS PHARMASCIENCE COL COLLINS LTD 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2024-04-01 2026-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 4464P PMS-DONEPEZIL 10MG TAB (PMS) DONEPEZIL PMS-DONEPEZIL 100'S A 40.77 0.41 TAB 30 BOTT PMS PHARMASCIENCE COL AVENTA BARBADOS 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
42 4464S DONEMAX 10MG TAB (JLP) DONEPEZIL DONEPEZIL DONEMAX 10X10 A 24.19 0.24 TAB 30 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 1204 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS 2026-04-01 2028-03-31 ORAL 6 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
40 4582A BERIATE 500IU INJ (CSL/AHI) FACTOR VIII FACTOR VIII BERIATE 10ML VIAL BQ 244.65 244.65 INJECTION 0 VIAL CSL CSL BEHRING AG AHI ARMSTRONG HEALTHCARE INC 202816 HEMOSTATICS 2022-04-01 2024-03-31 IV 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS