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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
40 A322JV VENLAFAXINE SR 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE SR 1000'S BP 516.21 0.52 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-09-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A322JY VENLAFAXINE SR 150MG TAB (WAT/AHI) VENLAFAXIN VENLAFAXINE VENLAFAXINE SR 90'S BP 64.32 0.71 TABLET 0 TAB WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-09-30 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A322KD LEXAPRO 20MG TAB (LUN/COL) ESCITALOPRAM ESCITALOPRAM LEXAPRO 14'S C 89.54 6.40 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KE EFFEXOR XR 75MG CAP (PFI/SBI) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KN FLUOXETINE 20MG TAB (APL/AHI) FLUOXETINE FLUOXETINE 1000'S A 120.97 0.12 TABLET 120 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-09-20 2024-03-31 Package Size Change oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-09-20
40 A322KR VENLAFAXINE ER 150MG CAP (APL/AHI) VENLAFAXIN VENLAFAXINE VENLAFAXINE ER 90'S BP 69.43 0.77 CAPSULE 0 CAP 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
40 A322KS VENLAFAXINE ER 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE ER 30'S BP 18.97 0.63 CAPSULE 0 CAP 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
40 A322KV EFFEXOR XR 150MG CAP (PFI/SBI) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Price Change Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-04-01
40 A322KX EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE VENLAFAXINE EFFEXOR XR 28'S C 135.59 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-07-12 2024-03-31 Package Size Change Oral CENTRAL NERVOUS SYSTEM DRUGS 2022-07-12
41 A322KX EFFEXOR XR 150MG XR CAP (PFI) VENLAFAXINE (C) VENLAFAXINE EFFEXOR XR 28'S C 136.81 4.8862 CAPXR 0 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
40 A322KY EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE VENLAFAXINE EFFEXOR XR 28'S C 135.59 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-07-12 2024-03-31 Package Size Change Oral CENTRAL NERVOUS SYSTEM DRUGS 2022-07-12
41 A322KY EFFEXOR XR 75MG XR CAP (PFI) VENLAFAXINE (C) VENLAFAXINE EFFEXOR XR 28'S C 136.81 4.8862 CAPXR 0 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE
41 A322LA APO-CITALOPRAM 20MG TAB (APO) CITALOPRAM APO-CITALOPRAM 30'S A 6.93 0.2311 TAB 42 BOX APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LB APO-ESCITALOPRAM 10MG TAB (APO) ESC (C) ESCITALOPRAM APO-ESCITALOPRAM 100'S C 14.98 0.1498 TAB 0 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LC APO-FLUOXETINE 20MG TAB (APO) FLUOXETINE APO-FLUOXETINE 100'S A 7.77 0.0777 TAB 42 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LD APO-PAROXETINE 20MG TAB (APO) PAROXETINE APO-PAROXETINE 100'S A 25.42 0.2542 TAB 42 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LE APO-SERTRALINE 50MG CAP (APO) SERTRALINE SERTRALINE APO-SERTRALINE 100'S A 12.15 0.1215 CAP 42 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LF APO-SERTRALINE 100MG CAP (APO) SERTRALINE APO-SERTRALINE 100'S A 19.41 0.1941 CAP 42 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LK APO-ESCITALOPRAM 20MG TAB (APO) (C) ESCITALOPRAM APO-ESCITALOPRAM 100'S C 29.96 0.2996 TAB 0 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
41 A322LU EFFEXOR 75MG XR CAP (PFI) VENLAFAXINE (C) VENLAFAXINE EFFEXOR 28'S C 136.81 4.8862 CAPXR 0 BOX PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS