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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 B051B DOLUTEGRAVIR 50MG TAB (APL/ATB) DOLUTEGRAVIR DOLUTEGRAVIR 30'S BL 10.66 0.36 TABLET 0 TAB APL AUROBINDO PHARMA LTD. ATB ANSA TRADING BARBADOS LTD 08180812 INTEGRASE INHIBITORS 2022-04-12 2024-03-31 Add to Contract as Cat B oral 0 ANTI-INFECTIVE AGENTS 2022-04-12
41 B051D DOLUTEGRAVIR 50MG TAB (MCP) (BL) DOLUTEGRAVIR DOLUTEGRAVIR 30'S BL 9.27 0.309 TAB 0 BOX MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 08180812 INTEGRASE INHIBITORS 2024-04-01 2024-12-27 ORAL 0 INTEGRASE INHIBITORS
41 B051D DOLUTEGRAVIR 50MG TAB (MCP) (BL) DOLUTEGRAVIR DOLUTEGRAVIR 30'S BL 10.53 0.351 TAB 0 BOX MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 08180812 INTEGRASE INHIBITORS 2024-12-28 2026-03-31 ORAL 0 INTEGRASE INHIBITORS 2024-12-27
40 B0611 VALDOXAN 25MG TAB (SER/STO) AGOMELATINE AGOMELATINE VALDOXAN 28'S BP 65.24 2.33 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 B0611 VALDOXAN 25MG TAB (SER) AGOMELATINE (BP) AGOMELATINE VALDOXAN 28'S BP 65.43 2.3368 TAB 84 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIDEPRESSANTS MISCELLANEOUS
42 B0611 VALDOXAN 25MG TAB (SER) AGOMELATINE AGOMELATINE VALDOXAN 28'S BP 65.43 2.34 TAB 84 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 ANTIDEPRESSANTS MISCELLANEOUS
40 B0612 VALDOXAN 25MG TAB (SER/COL) AGOMELATINE AGOMELATINE VALDOXAN 28'S BP 65.24 2.33 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 B0612 VALDOXAN 25MG TAB (SER) AGOMELATINE (BP) AGOMELATINE VALDOXAN 28'S BP 65.43 2.3368 TAB 84 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIDEPRESSANTS MISCELLANEOUS
42 B0612 VALDOXAN 25MG TAB (SER) AGOMELATINE AGOMELATINE VALDOXAN 28'S BP 65.43 2.34 TAB 84 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 28160492 ANTIDEPRESSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 0 ANTIDEPRESSANTS MISCELLANEOUS
40 B0718 KEPPRA 500MG TAB (GSK/COL) LEVETIRACETAM LEVETIRACETAM KEPPRA 30'S C 76.33 2.54 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 B0718 KEPPRA 500MG TAB (GSK) LEVETIRACETA (B) LEVETIRACETAM KEPPRA 30'S B 83.97 2.799 TAB 120 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 B0718 KEPPRA 500MG TAB (GSK) LEVETIRACETA LEVETIRACETAM KEPPRA 30'S C 87.88 2.93 TAB 120 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 B071A KEPPRA 1G TAB (GSK/COL) LEVETIRACETAM LEVETIRACETAM KEPPRA 30'S C 97.04 3.23 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 B071A KEPPRA 1G TAB (GSK) LEVETIRACETAM (B) LEVETIRACETAM KEPPRA 30'S B 106.75 3.5583 TAB 60 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 B071A KEPPRA 1G TAB (GSK) LEVETIRACETAM LEVETIRACETAM KEPPRA 30'S C 112.08 3.74 TAB 60 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 B071AJ LITEM 1G TAB (JLP) LEVETIRACETAM LEVETIRACETAM LITEM 10X10 B 35.34 0.35 TAB 60 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 B071AK LITEM 500MG TAB (JLP) LEVETIRACETAM LEVETIRACETAM LITEM 10X10 B 24.46 0.24 TAB 120 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
41 B071D QUETRA 500MG TAB (REM) LEVETIRACETA LEVETIRACETAM QUETRA 30'S BQ 11.77 0.3923 TAB 120 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-02 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS 2024-04-02
40 B071F LEVETIRACETAM 500MG TAB (REM/SBI) LEVETIRACETAM LEVETIRACETAM 100'S B 23.46 0.23 TABLET 0 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 B071F LEVETIRACETAM 500MG TAB (REM) (B) LEVETIRACETAM LEVETIRACETAM 100'S B 39.12 0.3912 TAB 120 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2024-05-14 ORAL 6 ANTICONVULSANTS MISCELLANEOUS 2024-04-02