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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 B071G KOPODEX 1G TAB (ABB/PHA) LEVETIRACETAM LEVETIRACETAM KOPODEX 30'S B 68.88 2.30 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 B071G KOPODEX 1G TAB (ABB/PHA) LEVETIRACETAM(B) LEVETIRACETAM KOPODEX 30'S B 68.88 2.296 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 6 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 B071H KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM LEVETIRACETAM KOPODEX 30'S C 58.55 1.95 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 B071H KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) LEVETIRACETAM KOPODEX 30'S C 58.55 1.9517 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 0 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) LEVETIRACETAM KOPODEX 30'S C 58.55 1.9517 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 0 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) LEVETIRACETAM KOPODEX 30'S C 58.55 1.9517 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 0 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) LEVETIRACETAM KOPODEXa 30'S C 58.55 1.9517 TABLET IMMED abc ABBOTT PHA PHARMACY SALES CARIBBEAN 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2023-03-31 Delete from contract Oral 0 ANTICONVULSANTS MISCELLANEOUS 2023-03-02
41 B071R LEVETIRACETAM 1G TAB (SGL) (B) LEVETIRACETAM LEVETIRACETAM 10X10 B 71.87 0.7187 TAB 60 BOX SGL STERIL-GENE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 B0731 KEPPRA 100MG/ML SYRUP (GSK/COL) LEVETIRACETAM LEVETIRACETAM KEPPRA 300ML B 91.72 0.31 SYRUP 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 B0731 KEPPRA 100MG/ML SYRUP (GSK) LEVETIRACETA LEVETIRACETAM KEPPRA 300ML B 100.9 0.3363 ML 900 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD B 281292 ANTICONVULSANTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
42 B0731 KEPPRA 100MG/ML SYRUP (GSK) LEVETIRACETA LEVETIRACETAM KEPPRA 300ML C 105.93 0.35 ML 900 BOTT GSK GLAXOSMITHKLINE COL AVENTA BARBADOS B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 B0735 LACETAM 100MG/ML SYR (LDP/AHI) LEVETIRACETAM LEVETIRACETAM LACETAM 300ML B 54.37 0.18 SYRUP 0 ML LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
42 B0738 LEVETRACETAM 100MG/ML SYR (INP) LEVETIRACETAM LEVETIRACETAM LEVETRACETAM 200ML B 23.08 0.12 ML 900 BOTT INP INTAS PHARMACEUTICALS LTD PHA PHARMACY SALES CARIBBEAN B 281292 ANTICONVULSANTS MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 ANTICONVULSANTS MISCELLANEOUS
40 B1511 PRADAX 75MG TAB (BOE/STO) DABIGATRAN DABIGATRAN PRADAX 3X10 BQ 88.75 2.96 TABLET 0 TAB BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2022-04-01 2024-03-31 Oral 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 B1511 PRADAX 75MG TAB (BOE) DABIGATRAN (BQ) DABIGATRAN PRADAX 3X10 BQ 96.64 3.2212 TAB 60 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2024-04-01 2026-03-31 ORAL 6 DIRECT THROMBIN INHIBITORS
42 B1511 PRADAX 75MG TAB (BOE) DABIGATRAN DABIGATRAN PRADAX 3X10 B 96.64 3.22 TAB 60 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 20120412 DIRECT THROMBIN INHIBITORS 2026-04-01 2028-03-31 ORAL 6 DIRECT THROMBIN INHIBITORS 2026-02-05
40 B1513 XARELTO 10MG TAB (BSP/AHI) RIVAROXABAN RIVAROXABAN XARELTO 10'S C 60.54 6.05 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 20120412 DIRECT THROMBIN INHIBITORS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
41 B1513 XARELTO 10MG TAB (BSP) RIVAROXABAN (C) RIVAROXABAN XARELTO 10'S C 60.54 6.0537 TAB 30 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 20120412 DIRECT THROMBIN INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIRECT THROMBIN INHIBITORS
42 B1513 XARELTO 10MG TAB (BSP) RIVAROXABAN RIVAROXABAN XARELTO 10'S C 30.36 3.04 TAB 30 BLIS BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 20120412 DIRECT THROMBIN INHIBITORS 2026-04-01 2028-03-31 ORAL 0 DIRECT THROMBIN INHIBITORS
40 B1514 XARELTO 10MG TAB (BSP/COL) RIVAROXABAN RIVAROXABAN XARELTO 10'S C 60.54 6.05 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 20120412 DIRECT THROMBIN INHIBITORS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS