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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 B5319 CASPOGIN 50MG INJ (CIP/AHI) CASPOFUNGIN CASPOFUNGIN CASPOGIN 10ML VIAL BQ 335.28 335.28 INJECTION 0 VIAL CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 081416 ECHINOCANDINS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
40 B5831 APO-NABILONE 1MG CAP (APO/COL) NABILONE APO-NABILONE 50'S A 66.00 1.32 CAPSULE 30 CAP APO APOTEX INC. COL COLLINS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 B5832 APO-NABILONE 0.25MG CAP (APO/COL) NABILONE APO-NABILONE 50'S A 23.05 0.46 CAPSULE 30 CAP APO APOTEX INC. COL COLLINS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 6 UNCLASSIFIED THERAPEUTIC AGENTS
41 B5911 AMLOTENSIVE CT 5MG|25MG TAB (CAR/COL) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.125 TAB 60 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 242892 CCBs, MISCELLANEOUS ORAL 6 CARDIOVASCULAR DRUGS
40 B5911 AMLOTENSIVE CT 5MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TABLET 60 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B5921 AMLOTENSIVE CT 5MG|50MG TAB (CAR/COL) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.9091 0.171 TAB 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS ORAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 B5921 AMLOTENSIVE CT 5MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.90 0.17 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2024-03-31 Add to Contract as Cat A Oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5931 AMLOTENSIVE CT 10MG|25MG TAB (CAR/COL) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.259 0.125 TAB 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS ORAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 B5931 AMLOTENSIVE CT 10MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2024-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5941 AMLOTENSIVE CT 10MG|50MG TAB (CAR/COL) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.9091 0.171 TAB 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS ORAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 B5941 AMLOTENSIVE CT 10MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.90 0.17 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2022-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B6211
41 B6211 GLYXAMBI 25MG|5MG TAB (BOE/STO) EMPAGLIFLOZIN|LINAGLIPTIN EMPAGLIFLOZIN|LINAGLIPTIN GLYXAMBI 30'S C 118.79 3.9597 TAB 0 TAB BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS Add to Contract as Cat C ORAL 0 HORMONES AND SYNTHETIC SUBSTITUTES
0 Brand C Brand Name Active Ingredient Trade Name Package Si Fo Pkg Price Unit Pric Unit Descrip Pack Man Manufacturer Name Age Agent Name B Therapeu Therapeutic Desc Status Description Default Route 0 Therapeutic Head
0 Brand C Brand Name Active Ingredient Trade Name Package Si Fo Pkg Price Unit Pric Unit Descrip 0 Pack Man Manufacturer Name Age Agent Name B Therapeu Therapeutic Desc Status Description Default Route 0 Therapeutic Head