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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 B4624 SYNJARDY 12.5MG|1G (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
41 B4625 DAPAGLIFLOZIN|METFORMIN 10MG|1G TAB (KWA) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN 30'S A 9.98 0.3325 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 B462D DAPAGLIFLOZIN|METFORMIN 10MG|1G XR TAB (ZHL) DAPAGLIFLOZIN|METFORMIN DAPAGLIFLOZIN|METFORMIN 3X10 A 8.13 0.27 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
40 B4811 VYMADA 24MG | 26MG TAB (NVS/COL) SACUBITRIL | VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 70.68 2.52 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4811 VYMADA 24MG|26MG TAB (NVS) SACUBITRIL|VALSARTAN (B) SACUBITRIL|VALSARTAN VYMADA 28'S B 65.24 2.33 TAB 60 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2024-04-01 2026-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
42 B4811 VYMADA 24MG|26MG TAB (NVS) SACUBITRIL|VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 48.93 1.75 TAB 60 BLIS NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
40 B4812 VYMADA 49MG | 51MG TAB (NVS/COL) SACUBITRIL | VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 70.68 2.52 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4812 VYMADA 49MG|51MG TAB (NVS) SACUBITRIL|VALSARTAN (B) SACUBITRIL|VALSARTAN VYMADA 28'S B 65.24 2.33 TAB 60 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2024-04-01 2026-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
42 B4812 VYMADA 49MG|51MG TAB (NVS) SACUBITRIL|VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 48.93 1.75 TAB 60 BLIS NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
40 B4813 VYMADA 97MG | 103MG TAB (NVS/COL) SACUBITRIL | VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 70.68 2.52 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4813 VYMADA 97MG|103MG TAB (NVS) SACUBITRIL|VALSARTAN (B) SACUBITRIL|VALSARTAN VYMADA 28'S B 65.24 2.33 TAB 60 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2024-04-01 2026-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
42 B4813 VYMADA 97MG|103MG TAB (NVS) SACUBITRIL|VALSARTAN SACUBITRIL|VALSARTAN VYMADA 28'S B 48.93 1.75 TAB 60 BLIS NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 243208 ANGIOTENSIN II RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 ANGIOTENSIN II RECEPTOR ANTAGONIST
40 B4911 XOLAIR 150MG INJ (NVS/COL) OMALIZUMAB OMALIZUMAB XOLAIR 150MG VIAL C 1,304.93 1,304.93 INJECTION 0 VIAL NVS NOVARTIS CARIBE SA COL COLLINS LTD 4810 RESPIRATORY INFLAMMATORY AGENTS 2022-04-01 2024-03-31 IV 0 RESPIRATORY TRACT AGENTS
41 B4911 XOLAIR 150MG INJ (NVS) OMALIZUMAB (C) OMALIZUMAB XOLAIR 150MG VIAL C 1304.93 1304.9314 VIAL 0 VIAL NVS NOVARTIS CARIBE SA COL COLLINS LTD 4810 RESPIRATORY INFLAMMATORY AGENTS 2024-04-01 2026-03-31 IV 0 RESPIRATORY INFLAMMATORY AGENTS
42 B4911 XOLAIR 150MG INJ (NVS) OMALIZUMAB OMALIZUMAB XOLAIR 150MG VIAL C 1,304.93 1,304.93 VIAL 0 VIAL NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 4810 RESPIRATORY INFLAMMATORY AGENTS 2026-04-01 2028-03-31 IV 0 RESPIRATORY INFLAMMATORY AGENTS
40 B4913 OMALIREL 150MG INJ (RLS/AHI) OMALIZUMAB OMALIZUMAB OMALIREL 150MG VIAL C 844.86 844.86 INJECTION 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2022-04-01 2024-03-31 IV 0 RESPIRATORY TRACT AGENTS
41 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB (C) OMALIZUMAB OMALIREL 150MG VIAL C 844.86 844.8551 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2024-04-01 2026-03-31 IV 0 RESPIRATORY INFLAMMATORY AGENTS
42 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB OMALIZUMAB OMALIREL 150MG VIAL BQ 747.54 747.54 VIAL 0 VIAL RLS RELIANCE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 4810 RESPIRATORY INFLAMMATORY AGENTS 2026-04-01 2028-03-31 IV 0 RESPIRATORY INFLAMMATORY AGENTS
40 B5012 ANORO ELLIPTA 55/22 INHR (GSK/COL) UMECLIDINI UMECLIDINIUM|VILANTEROL ANORO ELLIPTA 30 DOSES BQ 141.60 141.60 INHALER 1 INHR GSK GLAXOSMITHKLINE COL COLLINS LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 B5012 ANORO ELLIPTA 55MCG|22MCG INHR (GSK) UMECLIDINIUM|VILANTEROL (BQ) UMECLIDINIUM|VILANTEROL ANORO ELLIPTA 30 DOSES BQ 108.68 108.6786 INHR 1 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2024-07-16 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS 2024-07-16