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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 0472A DAPSONE 100MG TAB (LDP) DAPSONE DAPSONE 100'S A 32.62 0.3262 TAB 90 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 081692 ANTIMYCOBACTERIALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIMYCOBACTERIALS, MISCELLANEOUS
41 0472J DAPSONE 100MG TAB (GSK) DAPSONE DAPSONE 1000'S A 141.35 0.1414 TAB 90 BOTT GSK GLAXOSMITHKLINE AHI ARMSTRONG HEALTHCARE INC 081692 ANTIMYCOBACTERIALS, MISCELLANEOUS 2024-07-05 2026-03-31 ORAL 6 ANTIMYCOBACTERIALS, MISCELLANEOUS 2024-07-05
40 0481A FLAGYL 400MG TAB (SFA/COL) METRONIDAZOLE METRONIDAZOLE FLAGYL 14'S A 5.44 0.39 TABLET 90 TAB SFA SANOFI AVENTIS COL COLLINS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0481AY METRONIDAZOLE 250MG TAB (HEA) METRONIDAZOLE METRONIDAZOLE 10X10 A 5.36 0.0536 TAB 90 BOX HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS
41 0481AZ AAP-METRONIDAZOLE 250MG TAB (APO) METRONIDAZOLE AAP-METRONIDAZOLE 500'S A 28.68 0.0574 TAB 90 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS
42 0481BA METRON EZE 400MG TAB (INF) METRONIDAZOLE METRONIDAZOLE METRON EZE 10X10 A 12.78 0.13 TAB 90 BLIS INF INFOCUS REMEDIES PVT RXP RX PRO INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS
42 0481BB FLAMYD 250MG TAB (INC) METRONIDAZOLE METRONIDAZOLE FLAMYD 100'S A 7.01 0.07 TAB 90 BLIS INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS
42 0481BC METROZOLE 250MG TAB (HEA) METRONIDAZOLE METRONIDAZOLE METROZOLE 10X10 A 5.30 0.05 TAB 90 BLIS HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 Price Change ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS 2025-10-31
40 0481K AAP-METRONIDAZOLE 250MG TAB (APO/COL) METRONIDAZOLE AAP-METRONIDAZOLE 500'S A 28.11 0.06 TABLET 90 TAB APO APOTEX INC. COL COLLINS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 0481K AAP-METRONIDAZOLE 250MG TAB (APO) METRONIDAZOLE AAP-METRONIDAZOLE 500'S A 42.54 0.09 TAB 90 BOTT APO APOTEX INC. COL AVENTA BARBADOS 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 ORAL 0 ANTIPROTOZOALS, MISCELLANEOUS
40 04826 METRONIDAZOLE + HANGERS 0.5% INJ (BRA/COL) METRONIDAZOLE METRONIDAZOLE 100ML B 1.85 1.85 INJECTION 0 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
41 04826 METRONIDAZOLE + HANGERS 0.5% INJ (BRA) (B) METRONIDAZOLE METRONIDAZOLE 100ML B 1.96 1.9572 BOTT 0 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 IV 0 ANTIPROTOZOALS, MISCELLANEOUS
42 04826 METRONIDAZOLE + HANGERS 0.5% INJ (BRA) METRONIDAZOLE METRONIDAZOLE 100ML B 2.12 2.12 BOTT 40 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 IV 0 ANTIPROTOZOALS, MISCELLANEOUS
42 0482AB METRONIDAZOLE 0.5% INJ (RTM) METRONIDAZOLE METRONIDAZOLE 10X100ML B 20.39 2.04 BOTT 40 BOTT RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 IV 0 ANTIPROTOZOALS, MISCELLANEOUS
41 0482AF METRONIDAZOLE 0.5% INJ (UNI) (B) METRONIDAZOLE METRONIDAZOLE 100ML B 1.88 1.8756 BOTT 0 BOTT UNI UNIQUE PHARMACEUTICAL LABORATORIES AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 IV 0 ANTIPROTOZOALS, MISCELLANEOUS
40 04861 EPAQ 0.75% VAG CR (PMA/AHI) METRONIDAZOLE METRONIDAZOLE EPAQ 40G A 27.46 27.46 VAGINAL CREA 1 TUBE PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 VAGINAL 0 ANTI-INFECTIVE AGENTS
41 04862 EPAQ 0.75% VAG CR (PMA) METRONIDAZOLE METRONIDAZOLE EPAQ 40G A 16.99 16.9895 TUBE 1 BOX PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2024-04-01 2026-03-31 VAGINAL 0 ANTIPROTOZOALS, MISCELLANEOUS
42 04863 EPAQ 0.75% VAG CR (GRM) METRONIDAZOLE METRONIDAZOLE EPAQ 40G A 26.64 26.64 TUBE 1 TUBE GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2026-04-01 VAGINAL 0 ANTIPROTOZOALS, MISCELLANEOUS
41 0487B METRONIDAZOLE 0.75% GEL (GLP) (C) METRONIDAZOLE METRONIDAZOLE 30G C 26.5852 26.5852 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 0832 TRICHOMONACIDES 2024-04-01 2026-03-31 TOPICAL 0 TRICHOMONACIDES
40 04935 HIPREX 1G TAB (PMA/AHI) HEXAMINE MANDELATE HEXAMINE MANDELATE HIPREX 20'S C 53.82 2.69 TABLET 0 TAB PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 0836 URINARY ANTI-INFECTIVES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS