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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 7811AC PROTRIDE 5MG TAB (HEA) FINASTERIDE FINASTERIDE PROTRIDE 3X10 A 6.82 0.2274 TAB 30 BOX HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 9208 5 ALPHA REDUCTASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 5 ALPHA REDUCTASE INHIBITORS
41 7811AE FINASTERIDE 5MG TAB (FSB) FINASTERIDE FINASTERIDE 30'S A 6.03 0.2012 TAB 30 BOX FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 9208 5 ALPHA REDUCTASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 5 ALPHA REDUCTASE INHIBITORS
42 7811AJ PROTRIDE 5MG TAB (HEA) FINASTERIDE FINASTERIDE PROTRIDE 3X10 A 6.66 0.22 TAB 30 BLIS HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 9208 5 ALPHA REDUCTASE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 5 ALPHA REDUCTASE INHIBITORS 2025-10-31
42 7811AL PROTRIDE 5MG TAB (HEA) FINASTERIDE FINASTERIDE PROTRIDE 3X10 A 6.69 0.22 TAB 30 BLIS HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 9208 5 ALPHA REDUCTASE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 5 ALPHA REDUCTASE INHIBITORS 2026-01-26
42 7811AM PROTRIDE 5MG TAB (HEA) FINASTERIDE FINASTERIDE PROTRIDE 3X10 A 6.69 0.22 TAB 30 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 9208 5 ALPHA REDUCTASE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 5 ALPHA REDUCTASE INHIBITORS 2026-02-27
40 7811M PMS-FINASTERIDE 5MG TAB (PMS/COL) FINASTERIDE PMS-FINASTERIDE 30'S A 5.44 0.18 TABLET 30 TAB PMS PHARMASCIENCE COL COLLINS LTD 9208 5 ALPHA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 7811P PROTRIDE 5MG TAB (HEA/RXP) FINASTERIDE FINASTERIDE PROTRIDE 3X10 A 6.77 0.23 TABLET 30 TAB HEA HEALTH 2000 INC RXP RX PRO INC 9208 5 ALPHA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 7911AA APO-CYCLOBENZAPRINE 10MG TAB (APO/COL) CYCLOBENZAPRINE APO-CYCLOBENZAPRINE 500'S A 271.83 0.54 TABLET 42 TAB APO APOTEX INC. COL COLLINS LTD 122004 CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS 2022-04-01 2024-03-31 Package Size Change Oral 6 AUTONOMIC DRUGS 2022-02-28
41 7911AB APO-CYCLOBENZAPRINE 10MG TAB (APO) CYCLOBENZAPRINE APO-CYCLOBENZAPRINE 500'S A 271.89 0.5438 TAB 42 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 122004 CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS 2024-04-01 2026-03-31 ORAL 6 CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS
42 7911AC APO-TIZANIDINE 4MG TAB (APO) TIZANIDINE APO-TIZANIDINE 100'S A 9.65 0.10 TAB 21 BOTT APO APOTEX INC. COL AVENTA BARBADOS 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS
42 7911AF NORGESIC 35MG|500MG TAB (GRM) ORPHENADRINE|PARACETAMOL ORPHENADRINE|PARACETAMOL NORGESIC 5X10 C 33.98 0.68 TAB 0 BLIS GRM GRIMANN S.A DE C.V. AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS
41 7911Q TIZANIDINE 4MG TAB (DRL) TIZANIDINE TIZANIDINE 150'S A 17.51 0.1167 TAB 21 BOX DRL DR. REDDY'S LABORATORIES LTD AHI ARMSTRONG HEALTHCARE INC 122020 NEUROMUSCULAR BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 0 NEUROMUSCULAR BLOCKING AGENTS
40 7911R NORGESIC 35MG | 500MG TAB (PMA/AHI) ORPHENADRINE | PARACETAMOL ORPHENADRINE|PARACETAMOL NORGESIC 10'S C 7.07 0.71 TABLET 0 TAB PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 7911R NORGESIC 35MG|500MG TAB (PMA) ORPHENADRINE|PARACETAMOL (C) ORPHENADRINE|PARACETAMOL NORGESIC 10'S C 8.15 0.8155 TAB 0 BOX PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS
40 7911T TIZANIDINE 4MG TAB (KWA/ATB) TIZANIDINE TIZANIDINE 10X10 A 30.47 0.30 TABLET 21 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 122020 NEUROMUSCULAR BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
42 7911W CYCLOBENZAPRINE 10MG TAB (CIP) CYCLOBENZAPRINE CYCLOBENZAPRINE 100'S A 10.41 0.10 TAB 42 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 122004 CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS 2026-04-01 2028-03-31 ORAL 6 CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS
40 7911Y SIRDALUD 4MG TAB (BCH/COL) TIZANIDINE TIZANIDINE SIRDALUD 30'S C 20.44 0.68 TABLET 0 TAB BCH SANDOZ COL COLLINS LTD 122020 NEUROMUSCULAR BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
41 7911Y SIRDALUD 4MG TAB (BCH) TIZANIDINE (C) TIZANIDINE SIRDALUD 30'S C 20.44 0.6814 TAB 21 BOX BCH SANDOZ COL COLLINS LTD 122020 NEUROMUSCULAR BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 0 NEUROMUSCULAR BLOCKING AGENTS
42 7911Y SIRDALUD 4MG TAB (BCH) TIZANIDINE TIZANIDINE SIRDALUD 30'S C 23.24 0.77 TAB 21 BLIS BCH SANDOZ COL AVENTA BARBADOS 122020 NEUROMUSCULAR BLOCKING AGENTS 2026-04-01 2028-03-31 ORAL 0 NEUROMUSCULAR BLOCKING AGENTS
40 7912E ORPHENADRINE 30MG/ML INJ (AKI/AHI) ORPHENADRINE ORPHENADRINE 10X2ML C 690.07 69.01 INJECTION 0 AMP AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 122092 SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS 2022-04-01 2022-09-30 IV 0 AUTONOMIC DRUGS 2022-03-29