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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
42 B4513 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 COL AVENTA BARBADOS B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 B4514 NATRIXAM 10MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.31 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 B4514 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 COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4514 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4514 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 COL AVENTA BARBADOS B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 2028-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
41 B451E AMLODIPINE/INDAPAMIDE 10MG|1.5MG MR TAB (HEA) AMLODIPINE|IND AMLODIPINE|INDAPAMIDE AMLODIPINE/INDAPAMIDE 3X10 A 3.72 0.124 TABMR 30 BOX HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09
41 B451F AMLODIPINE/INDAPAMIDE 5MG|1.5MG MR TAB (HEA) AMLODIPINE|INDA AMLODIPINE|INDAPAMIDE AMLODIPINE/INDAPAMIDE 3X10 A 3.64 0.1213 TABMR 30 BOX HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09
41 B4612 XIGDUO 5MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S A 39.36 1.312 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2024-06-30 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-03-13
41 B4612 XIGDUO 5MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S B 39.36 1.312 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16
42 B4612 XIGDUO 5MG|1G XR TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S C 40.67 1.36 TAB 30 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2026-04-01 2028-03-31 ORAL 0 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
41 B4613 DAPAGLIFLOZIN|METFORMIN 5MG|1G TAB (KWA) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN 30'S A 8.32 0.2773 TAB 30 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
42 B4616 DAPAGLIFLOZIN|METFORMIN 5MG|1G TAB (ZHL) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN 3X10 A 6.33 0.21 TAB 30 BLIS ZHL ZENITH HEALTHCARE LIMITED SBI MASSY DISTRIBUTION (BDOS) LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2026-04-01 2028-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
41 B4622 XIGDUO 10MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S A 61.6 2.0532 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2024-06-30 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-03-13
41 B4622 XIGDUO 10MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S B 61.6 2.0533 TAB 30 BOX AZN ASTRAZENECA AB COL COLLINS LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-08-16
42 B4622 XIGDUO 10MG|1G XR TAB (AZN) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN XIGDUO 30'S C 61.60 2.05 TAB 30 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2026-04-01 2028-03-31 ORAL 0 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
40 B4623 SYNJARDY 12.5/850MG EMPAGLIFLOZIN/METFORMIN SYNJARDY 60'S A $67.25 $1.120 TABLETS 60 TAB BOE BOEHRINGER INGELHEIM STO BRYDENSTOKES LTD B 682018 SODIUM GLUCOSE CO-TRANSPORTER INHIBITOR/BIGUANIDE 2022-10-31 2024-03-31 ORAL 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B4623 SYNJARDY 12.5MG|850MG (BOE) EMPAGLIFLOZIN|METFORMIN EMPAGLIFLOZIN|METFORMIN SYNJARDY 60'S A 67.25 1.1209 TAB 60 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
42 B4623 SYNJARDY 12.5MG|850MG (BOE) EMPAGLIFLOZIN|METFORMIN EMPAGLIFLOZIN|METFORMIN SYNJARDY 60'S A 67.25 1.12 TAB 60 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2026-04-01 2028-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
40 B4624 SYNJARDY 12.5/1 G TAB (STO/BOE) EMPAGLIFLOZIN/METFORMIN SYNJARDY 60'S A $67.25 $1.120 TABLET 60 TAB BOE BOEHRINGER INGELHEIM STO BRYDENSTOKES LTD B 682018 SODIUM-GLUCOSE CO-TRANSPORTER HIBITOR/BIGUANIDE 2022-10-31 2024-03-31 ORAL 6 HORMONES AND SYNTHETIC SUBSTITUTES
41 B4624 SYNJARDY 12.5MG|1G (BOE) EMPAGLIFLOZIN|METFORMIN EMPAGLIFLOZIN|METFORMIN SYNJARDY 60'S A 67.25 1.1209 TAB 60 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 682018 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR 2024-04-01 2026-03-31 ORAL 6 SODIUM-GLUCOSE COTRANSPORTER INHIBITOR