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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 A2712 FML LIQUIFILM 0.1% EYE DR (ALL) FLUOROME FLUOROMETHOLONE FML LIQUIFILM 5ML C 17.67 17.67 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS 5208 EENT ANTI-INFLAMMATORY AGENTS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS
40 A271A AFM 0.1% EYE DR (ARP/AHI) FLUOROMETHOLONE FLUOROMETHOLONE AFM 5ML BQ 6.58 6.58 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A271A AFM 0.1% EYE DR (ARP) FLUOROMETHOLONE (BQ) FLUOROMETHOLONE AFM 5ML BQ 7.42 7.421 BOTT 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS
41 A271C E-FLOW 0.1% EYE DR (SHC) FLUOROMETHOLONE (BQ) FLUOROMETHOLONE E-FLOW 5ML BQ 4.08 4.0775 BOTT 0 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5208 EENT ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS
42 A271C E-FLOW 0.1% EYE DR (SHC) FLUOROMETHOLONE FLUOROMETHOLONE E-FLOW 5ML BQ 4.30 4.29 BOTT 0 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5208 EENT ANTI-INFLAMMATORY AGENTS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS
40 A2921 ARAVA 20MG TAB (SFA/COL) LEFLUNOMIDE LEFLUNOMIDE ARAVA 30'S C 95.14 3.17 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS
41 A2921 ARAVA 20MG TAB (SFA) LEFLUNOMIDE (C) LEFLUNOMIDE ARAVA 30'S C 95.14 3.1714 TAB 0 BOX SFA SANOFI AVENTIS COL COLLINS LTD 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2024-04-01 2026-03-31 ORAL 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS
42 A2921 ARAVA 20MG TAB (SFA) LEFLUNOMIDE LEFLUNOMIDE ARAVA 30'S C 95.14 3.17 TAB 0 BLIS SFA SANOFI COL AVENTA BARBADOS 9236 DISEASE MODIFYING ANTIRHEUMATIC AGENTS 2026-04-01 2028-03-31 ORAL 0 DISEASE MODIFYING ANTIRHEUMATIC AGENTS
40 A3131 SAIZEN 6MG INJ (MEK/COL) SOMATROPIN SOMATROPIN SAIZEN VIAL C 247.10 247.10 INJECTION 0 VIAL MEK MERCK SERONO COL COLLINS LTD 683004 SOMATROPHIN AGONIST 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 A321AH VENLAFAXINE ER 37.5MG TAB (APL/AHI) VENLAFAXI VENLAFAXINE VENLAFAXINE ER 30'S BP 10.90 0.36 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 A321AJ VENLAFAXINE 37.5MG TAB (ZYD) VENLAFAXINE VENLAFAXINE 100'S BP 11.1451 0.1115 TAB 42 BOTT ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A321AJ VENLAFAXINE 37.5MG TAB (ZYD) VENLAFAXINE VENLAFAXINE 100'S BP 12.15 0.12 TAB 42 BLIS ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A321AK APO-SERTRALINE 50MG CAP (APO) SERTRALINE APO-SERTRALINE 100'S A 12.15 0.12 CAP 42 BOTT APO APOTEX INC. COL AVENTA BARBADOS 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A321AL ZOLOFT 50MG TAB (PFI) SERTRALINE SERTRALINE ZOLOFT 14'S C 19.68 1.41 TAB 42 BLIS PFI PFIZER CORPORATION COL AVENTA BARBADOS 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A321AR PAXIL 12.5MG CR CAP (GSK) PAROXETINE PAROXETINE PAXIL 30'S C 53.99 1.80 CAP 0 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 ANTIDEPRESSANTS MISCELLANEOUS
42 A321AS LEEPAROX 12.5MG CR TAB (JLP) PAROXETINE PAROXETINE LEEPAROX 100'S BP 13.18 0.13 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 ANTIDEPRESSANTS MISCELLANEOUS
42 A321AT SETMAX 50MG TAB (JLP) SERTRALINE SERTRALINE SETMAX 10X10 A 12.23 0.12 TAB 42 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTIDEPRESSANTS MISCELLANEOUS
40 A321S VENLAFAXINE SR 37.5MG CAP (CIP/AHI) VENLAFAXINE VENLAFAXINE SR 100'S BP 35.20 0.35 CAPSULE 0 CAP CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A3221 APO-FLUOXETINE 20MG CAP (APO/COL) FLUOXETINE APO-FLUOXETINE 100'S A 7.61 0.08 CAPSULE 120 CAP APO APOTEX INC. COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
42 A3221 APO-FLUOXETINE 20MG CAP (APO) FLUOXETINE APO-FLUOXETINE 100'S A 7.77 0.08 CAP 120 BOTT APO APOTEX INC. COL AVENTA BARBADOS 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS