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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 B4321 CONCOR AM 5MG|5MG TAB (MEK) AMLODIPINE|BISOPROLOL (C) AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 36.15 1.2051 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 B4321 CONCOR AM 5MG|5MG TAB (MEK) AMLODI (C) AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 57.08 1.90 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 2028-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 B4323 BISOJOY AM 5MG|5MG TAB (ZYD) AMLOD (C) AMLODIPINE|BISOPROLOL BISOJOY AM 10X10 C 50.45 0.50 TAB 30 PACK ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 2028-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 B4331 CONCOR AM 5MG | 10MG TAB (MEK/COL) AMLODIPINE | BISOPROLOL AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 41.32 1.38 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 B4331 CONCOR AM 5MG|10MG TAB (MEK) AMLODIPINE|BISOPROLOL AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 41.32 1.3773 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 B4331 CONCOR AM 5MG|10MG TAB (MEK) AMLOD (C) AMLODIPINE|BISOPROLOL CONCOR AM 30'S C 66.60 2.22 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 2028-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 B441L TRIVERAM 5MG|20MG|5MG TAB (SER) AM (C) AMLODIPINE|ATORVASTATIN|PERINDOPRIL TRIVERAM 30'S C 63.76 2.13 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL ACE INHIBITORS 2026-04-07
42 B441M TRIVERAM 10MG|20MG|10MG TAB (SER) (C) AMLODIPINE|ATORVASTATIN|PERINDOPRIL TRIVERAM 30'S C 69.93 2.33 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL ACE INHIBITORS 2026-04-07
42 B441N TRIVERAM 5MG|20MG|10MG TAB (SER) A (C) AMLODIPINE|ATORVASTATIN|PERINDOPRIL TRIVERAM 30'S C 66.70 2.22 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL ACE INHIBITORS 2026-04-07
42 B441P TRIVERAM 5MG|10MG|5MG TAB (SER) AM (C) AMLODIPINE|ATORVASTATIN|PERINDOPRIL TRIVERAM 30'S C 60.82 2.03 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 243204 ACE INHIBITORS 2026-04-01 2028-03-31 ORAL ACE INHIBITORS 2026-04-07
40 B4511 NATRIXAM 5MG | 1.5MG TAB (SER/STO) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) A (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 B4513 NATRIXAM 5MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-05-01
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01