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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 6691M ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 26.61 26.61 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2026-04-01 2028-03-31 ORAL 0 ESTROGENS
41 6691N ANGELIQ 1MG E/2MG D TAB (BSP) ESTRADIOL/ (C) DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 26.61 26.6124 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 0 ESTROGENS
42 6691N ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 24.22 24.22 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 681604 ESTROGENS 2026-04-01 2028-03-31 ORAL 0 ESTROGENS
40 6691S PROGYNOVA 1MG TAB (BSP/COL) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 10.33 10.33 TABLET 1 PACK BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 6691S PROGYNOVA 1MG TAB (BSP) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 10.33 10.3296 PACK 1 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 6 ESTROGENS
42 6691S PROGYNOVA 1MG TAB (BSP) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 10.87 10.87 PACK 1 BOX BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 681604 ESTROGENS 2026-04-01 2028-03-31 ORAL 6 ESTROGENS
40 6691T PROGYNOVA 2MG TAB (BSP/COL) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 11.96 11.96 TABLET 1 PACK BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 6691T PROGYNOVA 2MG TAB (BSP) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 11.96 11.9606 PACK 1 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 6 ESTROGENS
42 6691T PROGYNOVA 2MG TAB (BSP) OESTRADIOL OESTRADIOL PROGYNOVA 28'S A 11.96 11.96 PACK 1 BOX BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 681604 ESTROGENS 2026-04-01 2028-03-31 ORAL 6 ESTROGENS
40 6711AL AVELOX 400MG TAB (BSP/COL) MOXIFLOXACIN MOXIFLOXACIN AVELOX 20'S C 182.13 9.11 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 081218 QUINOLONES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 6711AL AVELOX 400MG TAB (BSP) MOXIFLOXACIN (C) MOXIFLOXACIN AVELOX 20'S C 182.13 9.1064 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 081218 QUINOLONES 2024-04-01 2026-03-31 ORAL 0 QUINOLONES
41 6711BB ZINDOLIN 500MG TAB (REM) CIPROFLOXACIN (C) CIPROFLOXACIN ZINDOLIN 10X10 C 16.96 0.1696 TAB 14 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081218 QUINOLONES 2024-04-01 2026-03-31 ORAL 0 QUINOLONES
42 6711BB ZINDOLIN 500MG TAB (REM) CIPROFLOXACIN CIPROFLOXACIN ZINDOLIN 10X10 C 24.82 0.25 TAB 14 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081218 QUINOLONES 2026-04-01 2028-03-31 ORAL 0 QUINOLONES
40 6711CR ELEQUINE 500MG TAB (JAC/STO) LEVOFLOXACIN LEVOFLOXACIN ELEQUINE 24'S C 190.15 7.92 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 6711CR ELEQUINE 500MG TAB (JAC) LEVOFLOXACIN (C) LEVOFLOXACIN ELEQUINE 24'S C 190.15 7.9228 TAB 14 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2024-04-01 2026-03-31 ORAL 0 QUINOLONES
42 6711CR ELEQUINE 500MG TAB (JAC) LEVOFLOXACIN LEVOFLOXACIN ELEQUINE 24'S C 190.15 7.92 TAB 14 BLIS JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2026-04-01 2028-03-31 ORAL 0 QUINOLONES
40 6711CT ELEQUINE 750MG TAB (JAC/STO) LEVOFLOXACIN LEVOFLOXACIN ELEQUINE 20'S C 301.46 15.07 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 6711CT ELEQUINE 750MG TAB (JAC) LEVOFLOXACIN (C) LEVOFLOXACIN ELEQUINE 20'S C 301.46 15.0731 TAB 14 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2024-04-01 2026-03-31 ORAL 0 QUINOLONES
42 6711CT ELEQUINE 750MG TAB (JAC) LEVOFLOXACIN LEVOFLOXACIN ELEQUINE 20'S C 301.46 15.07 TAB 14 BLIS JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 081218 QUINOLONES 2026-04-01 2028-03-31 ORAL 0 QUINOLONES
40 6711CY CIPROFLOXACIN 500MG TAB (HEA/RXP) CIPROFLOXACIN CIPROFLOXACIN 10X10 A 14.81 0.15 TABLET 14 TAB HEA HEALTH 2000 INC RXP RX PRO INC 081218 QUINOLONES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS