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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 B0427 PANTOPRAZOLE 40MG INJ (CIP/AHI) PANTOPRAZOLE PANTOPRAZOLE 40MG VIAL B 2.61 2.61 INJECTION 0 VIAL CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2022-04-01 2022-09-30 IV 0 GASTROINTESTINAL DRUGS 2022-03-29
42 B0427 PANTOPRAZOLE 40MG INJ (CIP) PANTOPRAZOLE PANTOPRAZOLE 40MG VIAL B 1.55 1.55 VIAL 7 VIAL CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2026-04-01 2028-03-31 IV 0 PROTON PUMP INHIBITORS
41 B042AN PANTOPRAZOLE 40MG INJ (FSB) (B) PANTOPRAZOLE PANTOPRAZOLE 40MG VIAL B 1.14 1.1417 VIAL 7 VIAL FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS
40 B042AP NEXIUM 40MG INJ (AZN/COL) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 10X5ML C 146.79 14.68 INJECTION 0 VIAL AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2022-06-15 Delete from contract IV 0 GASTROINTESTINAL DRUGS 2022-05-04
40 B042AV PANSALVE 40MG INJ (EMC/COL) PANTOPRAZOLE PANTOPRAZOLE PANSALVE 40MG VIAL B 1.17 1.17 INJECTION 0 VIAL EMC EMCURE PHARMACEUTICALS LTD COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 IV 0 GASTROINTESTINAL DRUGS
40 B042AW EMEP 40MG INJ (ARP/AHI) ESOMEPRAZOLE ESOMEPRAZOLE EMEP 40MG VIAL C 7.94 7.94 INJECTION 0 VIAL ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 IV 0 GASTROINTESTINAL DRUGS
41 B042AW EMEP 40MG INJ (ARP) ESOMEPRAZOLE (C) ESOMEPRAZOLE EMEP 40MG VIAL C 5.44 5.4366 VIAL 0 VIAL ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS
40 B042BJ OMEPRAZOLE 40MG INJ (CHC/ATB) OMEPRAZOLE OMEPRAZOLE 40MG VIAL B 1.03 1.03 INJECTION 0 VIAL CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 IV 0 GASTROINTESTINAL DRUGS
40 B042BL NEXIUM 40MG INJ (AZN/COL) PANTOPRAZOLE PANTOPRAZOLE NEXIUM 5ML VIAL C 14.68 14.68 INJECTION 0 VIAL AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-05-04 2024-03-31 Package Size Change ORAL 0 GASTROINTESTINAL DRUGS 2022-05-04
41 B042BL NEXIUM 40MG INJ (AZN) PANTOPRAZOLE (B) PANTOPRAZOLE NEXIUM 5ML VIAL B 14.35 14.3528 VIAL 7 VIAL AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS
42 B042BL NEXIUM 40MG INJ (AZN) PANTOPRAZOLE PANTOPRAZOLE NEXIUM 5ML VIAL C 14.35 14.35 VIAL 7 VIAL AZN ASTRAZENECA AB COL AVENTA BARBADOS 562836 PROTON PUMP INHIBITORS 2026-04-01 2028-03-31 IV 0 PROTON PUMP INHIBITORS
41 B042BW OMEPRAZOLE 40MG INJ PWDR FOR SOLN (FSB) (B) OMEPRAZOLE OMEPRAZOLE 40MG VIAL B 1.14 1.1417 VIAL 0 VIAL FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS
41 B042BX LASPRAZOLE 40MG INJ (LDP) PANTOPRAZOLE (B) PANTOPRAZOLE LASPRAZOLE 10X10ML B 26.75 2.6748 VIAL 7 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS
42 B042BZ PANTOPRAZOLE 40MG INJ (ZHL) PANTOPRAZOLE PANTOPRAZOLE 40MG VIAL B 2.45 2.45 VIAL 7 VIAL ZHL ZENITH HEALTHCARE LIMITED SBI MASSY DISTRIBUTION (BDOS) LTD 562836 PROTON PUMP INHIBITORS 2026-04-01 2028-03-31 IV 0 PROTON PUMP INHIBITORS
42 B042CA PARIDEM 40MG INJ (EMC) PANTOPRAZOLE PANTOPRAZOLE PARIDEM 40MG VIAL B 4.89 4.89 VIAL 7 VIAL EMC EMCURE PHARMACEUTICALS LTD COL AVENTA BARBADOS 562836 PROTON PUMP INHIBITORS 2026-04-01 2028-03-31 IV 0 PROTON PUMP INHIBITORS
40 B0511 ISENTRESS 400MG TAB (MSD/STO) RALTEGRAVIR RALTEGRAVIR ISENTRESS 60'S BL 1,113.70 18.56 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 08180812 INTEGRASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 B0511 ISENTRESS 400MG TAB (MSD) RALTEGRAVIR (BL) RALTEGRAVIR ISENTRESS 60'S BL 917.68 15.2946 TAB 120 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 08180812 INTEGRASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 INTEGRASE INHIBITORS
41 B0517 TIVICAY 50MG TAB (GSK) DOLUTEGRAVIR (C) DOLUTEGRAVIR TIVICAY 30'S C 782.14 26.0714 TAB 0 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 08180812 INTEGRASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 INTEGRASE INHIBITORS
42 B0517 TIVICAY 50MG TAB (GSK) DOLUTEGRAVIR DOLUTEGRAVIR TIVICAY 30'S C 821.23 27.37 TAB 0 BOTT GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 08180812 INTEGRASE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 INTEGRASE INHIBITORS
40 B051A ZEPDON 400MG TAB (CIP/AHI) RALTEGRAVIR RALTEGRAVIR ZEPDON 60'S BL 219.89 3.66 TABLET 0 TAB CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 08180812 INTEGRASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS