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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 7621AN YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL (C) DROSPIRENONE|ETHINYL ESTRADIOL YAZ 28'S C 19.03 19.0283 PACK 0 BOTT BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
42 7621AN YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL DROSPIRENONE|ETHINYL ESTRADIOL YAZ 28'S C 19.03 19.03 PACK 0 BLIS BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2026-04-01 2028-03-31 ORAL 0 CONTRACEPTIVES
40 7621AW ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL | LEVONORGESTREL ETHINYL ESTRADIOL|LEVONORGESTREL ALYSENA 21'S C 13.59 13.59 TABLET 0 PACK APO APOTEX INC. COL COLLINS LTD 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621AX ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL | LEVONORGESTRE ETHINYL ESTRADIOL|LEVONORGESTREL ALYSENA 28'S C 13.59 13.59 TABLET 0 PACK APO APOTEX INC. COL COLLINS LTD 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621AZ CICLOTAB 20MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621AZ CICLOTAB 20MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-02
40 7621BB CICLOTAB 30MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BB CICLOTAB 30MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-07
40 7621BC DIXI 35 2MG | 35MCG TAB (ABB/PHA) CYPROTERONE | ETHINYL ESTRADIOL CYPROTERONE|ETHINYL ESTRADIOL DIXI 35 21'S C 12.07 0.57 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BC DIXI 35 2MG C/35MCG E TAB (ABB/PHA) CYPROTERO (C) CYPROTERONE|ETHINYL ESTRADIOL DIXI 35 21'S C 12.07 0.5748 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-02
40 7621BD MIA 3MG | 0.03MG TAB (ABB/PHA) DROSPIRENONE | ETHINYL ESTRADIOL DROSPIRENONE|ETHINYL ESTRADIOL MIA 28'S C 21.34 21.34 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BD MIA 3MG D/0.03MG EE TAB (ABB/PHA) DROSP/EE (C) DROSPIRENONE|ETHINYL ESTRADIOL MIA 28'S C 21.34 21.34 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-02
40 7621BE MIA 3MG | 0.02MG TAB (ABB/PHA) DROSPIRENONE | ETHINYL ESTRADIOL DROSPIRENONE|ETHINYL ESTRADIOL MIA 28'S C 19.52 19.52 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BE MIA 3MG D/0.02MG EE TAB (ABB/PHA) DROSP/EE (C) DROSPIRENONE|ETHINYL ESTRADIOL MIA 28'S C 19.52 19.52 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-07
40 7621BF PRIMAFEN 30MCG | 150MCG TAB (ABB/PHA) ETHINYLESTRADIOL | LEVONORGESTRE ETHINYL ESTRADIOL|LEVONORGESTREL PRIMAFEN 21'S C 4.57 4.57 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BF PRIMAFEN 30MCG|150MCG TAB (ABB/PHA) ETHINYLESTRADIOL|LEVONORGESTRE (C) ETHINYL ESTRADIOL|LEVONORGESTREL PRIMAFEN 21'S C 4.57 4.57 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-02
41 7621BM MINIGYNON 30MCG|50MCG TAB (BSP) ETHINYL ESTRADIOL|LEVONORGES (C) ETHINYL ESTRADIOL|LEVONORGESTREL MINIGYNON 21'S C 2.72 0.1294 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
41 7621BN ETHINYL ESTRADIOL|LEVONORGESTREL 30MCG|150MCG TAB (APO) (C) ETHINYL ESTRADIOL|LEVONORGESTREL ETHINYL ESTRADIOL|LEVONORGESTREL 28'S C 4.57 0.1631 TAB 0 BOX APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
41 7621BP APO-DROSPIRENONE|ETHINYL ESTRADIOL 3MG TAB (APO) (C) DROSPIRENONE|ETHINYL ESTRADIOL APO-DROSPIRENONE|ETHINYL ESTRADIOL 28'S C 9.7 9.7044 PACK 0 BOX APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
41 7621BU MINIGYNON 30MCG|50MCG TAB (BSP) ETHINYL ESTRADIOL|LEVONORGES (C) ETHINYL ESTRADIOL|LEVONORGESTREL MINIGYNON 21'S C 2.72 2.7183 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES