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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
41 B2256 NOVOMIX 70|30 FLEXPENS 100U/ML INJ (NOV) ASPART INSULIN ASPART NOVOMIX 70|30 FLEXPENS 5X3ML A 122.32 24.464 BOX 2 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS 2024-03-05
42 B2256 NOVOMIX 70|30 FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART INSULIN ASPART NOVOMIX 70|30 FLEXPENS 5X3ML A 122.32 24.46 BOX 2 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 2028-03-31 SC 6 INSULINS
41 B2258 HUMALOG 75%|25% INJ (LIL) INSULIN ISOPHANE|INSULIN REGULAR (C) INSULIN ISOPHANE|INSULIN RAPID HUMALOG 5X3ML C 134.69 26.9386 VIAL 0 BOX LIL ELI LILLY S.A.(PUERTO RICO BRA) STO BRYDEN STOKES LTD 682008 INSULINS 2024-04-01 2026-03-31 SC 0 INSULINS
40 B225A HUMULIN CARTRIDGE 70% | 30% INJ (LIL/STO) INSULIN ISOPHANE | INSULIN REGULAR INSULIN ISOPHANE|INSULIN REGULAR HUMULIN CARTRIDGE 5X3ML A 47.03 9.41 INJECTION 5 VIAL LIL ELI LILLY S.A.(PUERTO RICO BRA) STO BRYDEN STOKES LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B225A HUMULIN CARTRIDGE 70%|30% INJ (LIL) INSULIN ISOPHANE|INSULIN (C) INSULIN ISOPHANE|INSULIN REGULAR HUMULIN CARTRIDGE 5X3ML C 52.41 52.41 CAR 5 VIAL LIL ELI LILLY S.A.(PUERTO RICO BRA) STO BRYDEN STOKES LTD 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
40 B225B NOVOLIN PENFIL 70% | 30% INJ (NOV/COL) INSULIN ISOPHANE | INSULIN REGULAR INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN PENFIL 5X3ML C 61.19 12.24 INJECTION 0 VIAL NOV NOVO NORDISK A/S COL COLLINS LTD B 682008 INSULINS 2022-04-01 2024-03-31 SC 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 B225B NOVOLIN PENFIL 70%|30% INJ (NOV) INSULIN ISOPHANE|INSULIN RE (C) INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN PENFIL 5X3ML C 61.16 12.2325 VIAL 5 BOX NOV NOVO NORDISK A/S COL COLLINS LTD 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B225B NOVOLIN PENFIL 70%|30% INJ (NOV) INSULIN ISOPHANE|INSULIN RE INSULIN ISOPHANE|INSULIN REGULAR NOVOLIN PENFIL 5X3ML A 61.16 12.23 VIAL 5 VIAL NOV NOVO NORDISK A/S COL AVENTA BARBADOS B 682008 INSULINS 2026-04-01 2028-03-31 SC 6 INSULINS
41 B225D HUMALOG KWIKPEN 75%|25% INJ (LIL) INSULIN ISOPHANE|INSULIN R (C) INSULIN ISOPHANE|INSULIN RAPID HUMALOG KWIKPEN 5X3ML C 139.29 27.8574 VIAL 0 BOX LIL ELI LILLY S.A.(PUERTO RICO BRA) STO BRYDEN STOKES LTD B 682008 INSULINS 2024-04-01 2026-03-31 SC 6 INSULINS
42 B2711 TRAJENTA 5MG TAB (BOE) LINAGLIPTIN LINAGLIPTIN TRAJENTA 30'S C 114.66 3.82 TAB 0 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
40 B2712 GALVUS 50MG TAB (NVS/COL) VIDAGLIPTIN VIDAGLIPTIN GALVUS 56'S B 32.62 0.58 TABLET 60 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2712 GALVUS 50MG TAB (NVS) VILDAGLIPTIN (C) VILDAGLIPTIN GALVUS 56'S C 32.62 0.5825 TAB 60 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 DIPEPTIDYL PEPTIDASE INHIBITORS
42 B2712 GALVUS 50MG TAB (NVS) VILDAGLIPTIN VILDAGLIPTIN GALVUS 56'S C 27.18 0.49 TAB 60 BLIS NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 DIPEPTIDYL PEPTIDASE INHIBITORS
40 B2713 JANUVIA 50MG TAB (MSD/STO) SITAGLIPTIN SITAGLIPTIN JANUVIA 28'S C 70.65 2.52 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2713 JANUVIA 50MG TAB (MSD) SITAGLIPTIN (C) SITAGLIPTIN JANUVIA 28'S C 67.12 2.397 TAB 0 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
40 B2714 JANUVIA 100MG TAB (MSD/STO) SITAGLIPTIN SITAGLIPTIN JANUVIA 28'S C 70.65 2.52 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 B2714 JANUVIA 100MG TAB (MSD) SITAGLIPTIN (C) SITAGLIPTIN JANUVIA 28'S C 67.12 2.397 TAB 0 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
42 B271A VILDALION 50MG TAB (STL) VIDAGLIPTIN VILDAGLIPTIN VILDALION 30'S B 1.74 0.06 TAB 60 BLIS STL STALLION LABORATORIES SBI MASSY DISTRIBUTION (BDOS) LTD B 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 2028-03-31 ORAL 6 DIPEPTIDYL PEPTIDASE INHIBITORS
42 B271AQ SITADIET 50MG TAB (JLP) SITAGLIPTIN SITAGLIPTIN SITADIET 10X10 C 14.68 0.15 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 2028-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS
41 B271E REMEVIA 100MG TAB (REM) SITAGLIPTIN (C) SITAGLIPTIN REMEVIA 28'S C 11.93 0.4262 TAB 0 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS