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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 B4217 FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI DAPAGLIFLOZIN FORXIGA 30'S A 61.6 2.0532 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2024-06-30 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-03-13
41 B4217 FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI DAPAGLIFLOZIN FORXIGA 30'S B 61.6 2.0533 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16
41 B4218 FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN DAPAGLIFLOZIN FORXIGA 30'S A 61.6 2.0532 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2024-04-24 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-03-13
41 B4218 FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN DAPAGLIFLOZIN FORXIGA 30'S B 61.6 2.0533 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16
41 B421A DAPAGLIFLOZIN 10MG TAB (KWA) DAPAGLIFLOZIN DAPAGLIFLOZIN 28'S A 7.77 0.2777 TAB 30 BOTT KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
41 B421H DAPAGLIFLOZIN 5MG TAB (MCP) DAPAGLIFLOZIN DAPAGLIFLOZIN 3X10 A 10.33 0.3443 TAB 30 BOX MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2024-10-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-09-19
41 B421M DAPAGLIFLOZIN 5MG TAB (MCP) DAPAGLIFLOZIN DAPAGLIFLOZIN 100'S A 34.44 0.3444 TAB 30 BLIS MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-10-29 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-09-20
40 B4321 CONCOR AM 5MG | 5MG TAB (MEK/COL) AMLODIPINE | BISOPROLOL AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 36.15 1.21 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 B4321 CONCOR AM 5MG|5MG TAB (MEK) AMLODIPINE|BISOPROLOL (C) AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 36.15 1.2051 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 B4331 CONCOR AM 5MG | 10MG TAB (MEK/COL) AMLODIPINE | BISOPROLOL AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 41.32 1.38 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 B4331 CONCOR AM 5MG|10MG TAB (MEK) AMLODIPINE|BISOPROLOL AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 41.32 1.3773 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 B4511 NATRIXAM 5MG | 1.5MG TAB (SER/STO) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) A (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
40 B4513 NATRIXAM 5MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-05-01
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
40 B4514 NATRIXAM 10MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.31 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS