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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
41 5131P T BET PRES. FREE 0.5%|0.004% EYE DR (AKU) TIMOLOL|TRAVOPROST (C) TIMOLOL|TRAVOPROST T BET PRES. FREE 3ML C 11.42 11.417 BOTT 1 BOTT AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 5131P T BET PRES. FREE 0.5%|0.004% EYE DR (AKU) TIMOLOL|TRAVOPROST TIMOLOL|TRAVOPROST T BET PRES. FREE 3ML BQ 11.44 11.44 BOTT 1 BOTT AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 2028-03-31 OPHTHALMIC 0 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 5131Q XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL LATANOPROST|TIMOLOL XALACOM 2.5ML C 34.58 34.58 BOTT 1 BOTT PFI PFIZER CORPORATION COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 2028-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
41 51516 ZIPRASIDONE 20MG CAP (DRL) (BP) ZIPRASIDONE ZIPRASIDONE 60'S BP 42.43 0.7072 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51516 ZIPRASIDONE 20MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 71.36 1.19 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51527 ZIPRASIDONE 40MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.35 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51527 ZIPRASIDONE 40MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.3537 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51527 ZIPRASIDONE 40MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 81.22 1.35 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51535 ZIPRASIDONE 60MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.72 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51535 ZIPRASIDONE 60MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.7239 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51535 ZIPRASIDONE 60MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 103.43 1.72 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51546 ZIPRASIDONE 80MG CAP (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.21 2.09 CAPSULE 0 CAP DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 51546 ZIPRASIDONE 80MG CAP (DRL) (BP) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.21 2.0868 CAP 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
42 51546 ZIPRASIDONE 80MG CAP (DRL) ZIPRASIDONE ZIPRASIDONE 60'S BP 125.15 2.09 CAP 84 BLIS DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 0 ATYPICAL ANTIPSYCHOTICS
40 51554 ZIPRASIDONE 20MG INJ (DRL/AHI) ZIPRASIDONE ZIPRASIDONE 10X1ML BP 1,259.32 125.93 INJECTION 0 VIAL DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Package Size Change IV 0 CENTRAL NERVOUS SYSTEM DRUGS 2021-12-16
41 51554 ZIPRASIDONE 20MG INJ (DRL) (BP) ZIPRASIDONE ZIPRASIDONE 10X1ML BP 1258.58 125.8584 VIAL 84 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 IV 6 ATYPICAL ANTIPSYCHOTICS
42 51554 ZIPRASIDONE 20MG INJ (DRL) ZIPRASIDONE ZIPRASIDONE 10X1ML BP 1,214.76 121.48 VIAL 84 VIAL DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 IV 0 ATYPICAL ANTIPSYCHOTICS
40 51714 ZENTEL 200MG TAB (GSK/COL) ALBENDAZOLE ALBENDAZOLE ZENTEL 2'S A 4.19 2.10 TABLET 6 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 0808 ANTHELMINTICS 2022-04-01 2024-03-31 Oral 1 ANTI-INFECTIVE AGENTS
41 5171AJ ALBENDAZOLE 200MG TAB (LDP) ALBENDAZOLE ALBENDAZOLE 2'S A 3.72 1.86 TAB 6 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 0808 ANTHELMINTICS 2024-04-01 2026-03-31 ORAL 1 ANTHELMINTICS 2023-11-21
40 5171AK ZENTEL 400MG TAB (GSK) ALBENDAZOLE ALBENDAZOLE ZENTEL 1 A $4.19 4.19 TABLET 3 TAB GSK GLAXOSMITHKLINE COL COLLINS LIMITED 0808 ANTHELMINTICS 0000-00-00 0000-00-00 ORAL 1 ANTI-INFECTIVE AGENTS