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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 56956 OPTIVIRAL 3% EYE OINT (SPC) ACYCLOVIR ACYCLOVIR OPTIVIRAL 5G A 2.36 2.36 TUBE 2 TUBE SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 520420 EENT ANTIVIRALS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTIVIRALS
40 56965 APO-ACYCLOVIR 400MG TAB (APO/COL) ACYCLOVIR APO-ACYCLOVIR 100'S A 29.90 0.30 TABLET 50 TAB APO APOTEX INC. COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 56965 APO-ACYCLOVIR 400MG TAB (APO) ACYCLOVIR APO-ACYCLOVIR 100'S A 30.50 0.31 TAB 50 BOTT APO APOTEX INC. COL AVENTA BARBADOS 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 56968 ACYCLOVIR DISP 400MG TAB (HEA/RXP) ACYCLOVIR ACYCLOVIR DISP 1X10 A 3.67 0.37 TABLET 50 TAB HEA HEALTH 2000 INC RXP RX PRO INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 5696AA ACYCLOVIR 400MG DISP TAB (HEA) ACYCLOVIR ACYCLOVIR 1X10 A 3.91 0.39 TAB 50 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-02-27
40 5696AB ACYCLOVIR DISP 400MG TAB (HEA/ATB) ACYCLOVIR ACYCLOVIR DISP 1X10 A 3.67 0.367 TABLET DISPE HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 81832 NUCLEOSIDES AND NUCLEOTIDES 2022-12-07 2024-03-31 Change Local Agent oral 0 NUCLEOSIDES AND NUCLEOTIDES 2022-11-25
41 5696AB ACYCLOVIR DISP 400MG TAB (HEA) ACYCLOVIR ACYCLOVIR 1X10 A 4.02 0.4023 TABDISP 50 BOX HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 5696AH ACYCLOVIR 400MG DISP TAB (HEA) ACYCLOVIR ACYCLOVIR 1X10 A 3.91 0.39 TAB 50 BLIS HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-01-26
42 5696W ACYCLOVIR 400MG DISP TAB (HEA) ACYCLOVIR ACYCLOVIR 1X10 A 3.91 0.39 TAB 50 BLIS HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES 2025-10-31
40 56975 ZOVIRAX 40MG/ML SUSP (GSK/COL) ACYCLOVIR ACYCLOVIR ZOVIRAX 125ML B 77.55 0.62 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
41 5697E ACYCLOVIR 40MG/ML SUSP (WAT) (B) ACYCLOVIR ACYCLOVIR 473ML B 593.85 1.2555 ML 10 BOTT WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 5697G ACICLOVIR 40MG/ML SUSP (CIR) ACYCLOVIR ACYCLOVIR ACICLOVIR 100ML A 8.16 0.08 ML 100 BOTT CIR CIRON PHARMA CWS CAPSULE WHOLESALE B 0818 ANTIVIRALS 2026-04-01 2028-03-31 ORAL 0 ANTIVIRALS
40 56985 APO-ACYCLOVIR 800MG TAB (APO/COL) ACYCLOVIR APO-ACYCLOVIR 100'S A 38.79 0.39 TABLET 50 TAB APO APOTEX INC. COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 56985 APO-ACYCLOVIR 800MG TAB (APO) ACYCLOVIR APO-ACYCLOVIR 100'S A 39.55 0.40 TAB 50 BOTT APO APOTEX INC. COL AVENTA BARBADOS 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 56988 CYCLOVAX 800MG TAB (REM/SBI) ACYCLOVIR ACYCLOVIR CYCLOVAX 1x10 C 4.13 0.41 TABLET 0 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 56988 CYCLOVAX 800MG TAB (REM) ACYCLOVIR ACYCLOVIR CYCLOVAX 1x10 A 6.5 0.6497 TAB 50 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 56988 CYCLOVAX 800MG TAB (REM) ACYCLOVIR (C) ACYCLOVIR CYCLOVAX 1x10 C 6.82 0.68 TAB 50 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 5698A ACYCLOVIR DISP 800MG TAB (HEA/RXP) ACYCLOVIR ACYCLOVIR DISP 1X10 C 6.52 0.65 TABLET 0 TAB HEA HEALTH 2000 INC RXP RX PRO INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 5698AA ACYCLOVIR 800MG DISP TAB (HEA) ACYCLOVIR ACYCLOVIR 1X10 B 6.85 0.69 TAB 50 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-02-27
40 5698AC ACYCLOVIR DISP 800MG TAB (HEA/ATB) (C) ACYCLOVIR ACYCLOVIR DISP 1X10 C 7 0.7 TABLET IMMED 0 HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 81832 NUCLEOSIDES AND NUCLEOTIDES 2022-07-12 la oral 0 NUCLEOSIDES AND NUCLEOTIDES