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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 B5931 AMLOTENSIVE CT 10MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2024-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5931 AMLOTENSIVE CT 10MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.259 0.125 TAB 30 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
42 B5931 AMLOTENSIVE CT 10MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 2028-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
40 B5941 AMLOTENSIVE CT 10MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.90 0.17 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2022-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5941 AMLOTENSIVE CT 10MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.9091 0.171 TAB 30 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
42 B5941 AMLOTENSIVE CT 10MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.91 0.17 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 2028-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
41 B6211 GLYXAMBI 25MG|5MG TAB (BOE) EMPAGL (C) EMPAGLIFLOZIN|LINAGLIPTIN GLYXAMBI 30'S C 118.79 3.9597 TAB 0 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS 2024-01-02
41 B7111 NURTEC 75 MG TABS(PFI) RIMEGEPANT RIMEGEPANT NURTEC 2'S C 87.17 43.58 TABS PFI PFIZER STO BRYDENSTOKES 28:32:12
42 B7111 NURTEC 75MG TAB (PFI) RIMEGEPANT RIMEGEPANT NURTEC 2'S C 87.01 43.51 TAB 2 BLIS PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 283212 CALCITONIN GENE-RELATED PEPTIDE ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 CALCITONIN GENE-RELATED PEPTIDE ANTAGONIST
42 B7112 NURTEC 75MG TAB (PFI) RIMEGEPANT RIMEGEPANT NURTEC 8'S C 348.05 43.51 TAB 2 BLIS PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 283212 CALCITONIN GENE-RELATED PEPTIDE ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 CALCITONIN GENE-RELATED PEPTIDE ANTAGONIST
42 B8012 FIRIALTA 10MG TAB (BSP) FINERENONE (C) FINERENONE FIRIALTA 28'S C 132.43 4.73 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 243220 ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-07
42 B8021 FIRIALTA 20MG TAB (BSP) FINERENONE (C) FINERENONE FIRIALTA 28'S C 132.43 4.73 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 243220 ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL ALDOSTERONE RECEPTOR ANTAGONIST 2026-04-07
0 Brand C Brand Name Active Ingredient Trade Name Package Si Fo Pkg Price Unit Pric Unit Descrip Pack Age Agent Name B Therapeu Therapeutic Desc Default Route 0 Therapeutic Head