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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 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT/AHI) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE 100'S A 56.16 0.56 TABLET 90 TAB WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE 100'S A 74.94 0.7494 TAB 90 BOX WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
41 A481F ISOSORBIDE MONONITRATE 10MG TAB (WAT) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE 56'S A 41.97 0.7495 TAB 90 BOX WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-12-19 2026-03-31 ORAL 6 NITRATES AND NITRITES 2024-12-19
40 A482F ISOSORBIDE MONONITRATE 20MG TAB (WAT/AHI) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE 100'S A 56.35 0.56 TABLET 90 TAB WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 A4839 MONOREM 60MG TAB (REM/SBI) ISOSORBIDE MONONIT ISOSORBIDE MONONITRATE MONOREM 3x10 A 4.65 0.16 TABLET 60 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 A4839 MONOREM 60MG TAB (REM) ISOSORBIDE MONONI ISOSORBIDE MONONITRATE MONOREM 3x10 A 5.76 0.1921 TAB 60 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
42 A4839 MONOREM 60MG TAB (REM) ISOSORBIDE MONONI ISOSORBIDE MONONITRATE MONOREM 3x10 A 7.58 0.25 TAB 60 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 241208 NITRATES AND NITRITES 2026-04-01 2028-03-31 ORAL 6 NITRATES AND NITRITES
40 A483B APO-ISMN 60MG TAB (APO/COL) ISOSORBIDE MONONITRATE APO-ISMN 100'S A 17.89 0.18 TABLET 60 TAB APO APOTEX INC. COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
42 A483B APO-ISMN 60MG TAB (APO) ISOSORBIDE MONONITRATE APO-ISMN 100'S A 18.24 0.18 TAB 60 BOTT APO APOTEX INC. COL AVENTA BARBADOS 241208 NITRATES AND NITRITES 2026-04-01 2028-03-31 ORAL 6 NITRATES AND NITRITES
40 A483F ISOSORBIDE MONONITRATE 60MG TAB (KWA/ATB) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE 3X10 A 4.08 0.14 TABLET 60 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 241208 NITRATES AND NITRITES 2022-04-01 2022-09-30 Oral 6 CARDIOVASCULAR DRUGS 2022-03-30
41 A483L APO-ISMN 60MG TAB (APO) ISOSORBIDE MONONITRATE APO-ISMN 100'S A 18.24 0.1824 TAB 60 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
42 A483N ISODIT 60MG SR TAB (JLP) ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE ISODIT 20X10 A 15.90 0.08 TAB 60 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 2028-03-31 ORAL 6 NITRATES AND NITRITES
40 A4921 ALPHAGAN P 0.1% EYE DR (ALL/COL) BRIMONIDINE BRIMONIDINE ALPHAGAN P 10ML C 45.94 45.94 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE (C) BRIMONIDINE ALPHAGAN P 10ML C 45.94 45.9397 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS
42 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE BRIMONIDINE ALPHAGAN P 10ML C 45.94 45.94 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS B 524004 EENT ALPHA ADRENERGIC AGONISTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS
42 A492AA BRENT LS 0.1% EYE DR (HAN) BRIMONIDINE BRIMONIDINE BRENT LS 10ML A 6.58 6.58 BOTT 1 BOTT HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA B 524004 EENT ALPHA ADRENERGIC AGONISTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS
42 A492AB BRIMONIDINE 0.1% EYE DR (FSB) BRIMONIDINE BRIMONIDINE 10ML A 2.17 2.17 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS 2026-03-05
40 A492B BRIMONIDINE 0.1% EYE DR (FSB/ATB) BRIMONIDINE BRIMONIDINE 10ML A 6.80 6.80 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A492B BRIMONIDINE 0.1% EYE DR (FSB) BRIMONIDINE BRIMONIDINE 10ML A 6.85 6.8502 BOTT 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS
41 A492FT BRIMONIDINE 0.1% EYE DR (CHC) BRIMONIDINE BRIMONIDINE 10ML A 2.66 2.664 BOTT 1 BOTT CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD B 524004 EENT ALPHA ADRENERGIC AGONISTS 2024-04-01 2026-03-31 OTIC/OPHTHALMIC 6 EENT ALPHA ADRENERGIC AGONISTS