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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 65712 CLOZAPINE 25MG TAB (APL) CLOZAPINE CLOZAPINE 100'S BP 122.9498 1.2295 TAB 270 BOX APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
40 65715 SKIZORIL 25MG TAB (INP/AAL) CLOZAPINE CLOZAPINE SKIZORIL 500'S BP 92.45 0.18 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
42 65717 PSYLOPINE 25MG TAB (JLP) CLOZAPINE CLOZAPINE PSYLOPINE 10X10 A 20.39 0.20 TAB 270 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
40 65726 CLOZAREM 100MG TAB (REM/SBI) CLOZAPINE CLOZAPINE CLOZAREM 5X10 B 25.36 0.51 TABLET 0 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 65726 CLOZAREM 100MG TAB (REM) CLOZAPINE CLOZAPINE CLOZAREM 5X10 BP 24.36 0.4871 TAB 270 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 28160804 ATYPICAL ANTIPSYCHOTICS 2024-04-01 2026-03-31 ORAL 9 ATYPICAL ANTIPSYCHOTICS
42 65726 CLOZAREM 100MG TAB (REM) CLOZAPINE CLOZAPINE CLOZAREM 5X10 A 24.46 0.49 TAB 168 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 28160804 ATYPICAL ANTIPSYCHOTICS 2026-04-01 2028-03-31 ORAL 6 ATYPICAL ANTIPSYCHOTICS
40 65811 LECTRUM 11.25MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM KIT C 462.31 462.31 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE (BQ) LEUPROLIDE LECTRUM KIT BQ 462.31 462.3054 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM KIT BQ 466.87 466.87 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 2028-03-31 IV 0 ANTINEOPLASTICS
40 6581C LECTRUM 3.75MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.97 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE (BQ) LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.9727 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM 3.75MG KIT BQ 173.97 173.97 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 2028-03-31 IV 0 ANTINEOPLASTICS
40 6581D LECTRUM 7.5MG INJ (BCH/COL) LEUPROLIDE LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.04 INJECTION 0 KIT BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
41 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE (C) LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.0397 KIT 0 BOX BCH SANDOZ COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IV 0 ANTINEOPLASTICS
42 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE LEUPROLIDE LECTRUM 7.5MG KIT C 369.04 369.04 KIT 0 BOX BCH SANDOZ COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 2028-03-31 IV 0 ANTINEOPLASTICS
40 6581R ZOLADEX 10.8MG KIT (AZN/COL) GOSERELIN GOSERELIN ZOLADEX 10.8MG KIT C 611.62 611.62 KIT 0 KIT AZN ASTRAZENECA AB COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IM 0 ANTINEOPLASTICS
41 6581R ZOLADEX 10.8MG KIT (AZN) GOSERELIN (C) GOSERELIN ZOLADEX 10.8MG KIT C 611.62 611.6229 KIT 0 BOX AZN ASTRAZENECA AB COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IM 0 ANTINEOPLASTICS
42 6581R ZOLADEX 10.8MG KIT (AZN) GOSERELIN GOSERELIN ZOLADEX 10.8MG KIT BQ 611.62 611.62 KIT 0 BOX AZN ASTRAZENECA AB COL AVENTA BARBADOS 1000 ANTINEOPLASTICS 2026-04-01 2028-03-31 IM 0 ANTINEOPLASTICS
40 6581S ZOLADEX 3.6MG KIT (AZN/COL) GOSERELIN GOSERELIN ZOLADEX 3.6MG KIT C 205.51 205.51 KIT 0 KIT AZN ASTRAZENECA AB COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IM 0 ANTINEOPLASTICS
41 6581S ZOLADEX 3.6MG KIT (AZN) GOSERELIN (C) GOSERELIN ZOLADEX 3.6MG KIT C 205.51 205.5053 KIT 0 BOX AZN ASTRAZENECA AB COL COLLINS LTD 1000 ANTINEOPLASTICS 2024-04-01 2026-03-31 IM 0 ANTINEOPLASTICS