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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 1212F NITRODERM TTS 5 25MG PATCH (BCH/COL) GLYCERYL GLYCERYL TRINITRATE NITRODERM TTS 5 10'S BQ 19.68 19.68 PATCH 0 PACK BCH SANDOZ COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2022-05-24 Delete from contract TOPICAL 0 CARDIOVASCULAR DRUGS 2022-04-12
40 1212G NITRODERM TTS 10 50MG PATCH (BCH/COL) GLYCERY GLYCERYL TRINITRATE NITRODERM TTS 10 10'S BQ 45.40 45.40 PATCH 0 PACK BCH SANDOZ COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2022-05-24 Delete from contract TOPICAL 6 CARDIOVASCULAR DRUGS 2022-04-12
41 12136 NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL (BQ) GLYCERYL TRINITRATE NITROGLYCERINE 25X5ML BQ 171.25 6.8502 AMP 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 IV 0 NITRATES AND NITRITES
42 12136 NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL GLYCERYL TRINITRATE NITROGLYCERINE 25X5ML BQ 171.93 6.88 AMPG 0 BOX SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 IV 0 NITRATES AND NITRITES
40 12138 GLYCERYL TRINITRATE 5MG/ML INJ (MON/PHA) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 5X5ML BQ 9.46 1.89 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
41 12138 GLYCERYL TRINITRATE 5MG/ML INJ (MON (BQ) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 5X5ML BQ 8.89 1.7778 AMP 0 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 IV 0 NITRATES AND NITRITES
40 12148 NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN GLYCERYL TRINITRATE NITROCARD 200 DOSES A 17.61 17.61 SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 12149 TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE GLYCERYL TRINITRATE TROCER 200 DOSES A 18.2671 18.2671 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL INHALATION 6 NITRATES AND NITRITES
42 12149 TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE GLYCERYL TRINITRATE TROCER 200 DOSES A 18.51 18.51 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 ORAL INHALATION 6 NITRATES AND NITRITES
40 12214 PIMECROLIMUS 1% CR (KWA/ATB) PIMECROLIMUS PIMECROLIMUS 15G C 57.08 57.08 CREAM 0 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 Topical 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 12314 ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA ISOSORBIDE DINITRATE ISOREM 100'S A 3.48 0.0348 TAB 180 BOTT REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
42 12314 ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA ISOSORBIDE DINITRATE ISOREM 100'S A 3.83 0.04 TAB 180 BOTT REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 241208 NITRATES AND NITRITES 2026-04-01 ORAL 6 NITRATES AND NITRITES
42 12315 AAP-ISDN 10MG TAB (APO) ISOSORBIDE DINITRATE AAP-ISDN 100'S A 8.97 0.09 TAB 180 BOTT APO APOTEX INC. COL AVENTA BARBADOS 241208 NITRATES AND NITRITES 2026-04-01 ORAL 6 NITRATES AND NITRITES
40 1231A ISOSORBIDE DINITRATE 10MG TAB (FSB/ATB) ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 100'S A 10.57 0.11 TABLET 180 TAB FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1231D AAP-ISDN 10MG TAB (APO/COL) ISOSORBIDE DINITRATE AAP-ISDN 100'S A 13.32 0.13 TABLET 180 TAB APO APOTEX INC. COL COLLINS LTD 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 1231T APO-ISOSORBIDE DINITRATE 10MG TAB (APO) (C) ISOSORBIDE DINITRATE APO-ISDN 100'S C 10.79 0.1079 TAB 180 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
41 1231U ISOSORBIDE DINITRATE 10MG TAB (MCP) ISOSORBIDE DINITRATE ISOSORBIDE 10X10 A 8.97 0.0897 TAB 180 BOX MCP MACLEODS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
42 1231W ISOSORBIDE DINITRATE 10MG TAB (FSB) ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 100'S A 2.75 0.03 TAB 180 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 241208 NITRATES AND NITRITES 2026-04-01 Add to Contract as Cat A ORAL 6 NITRATES AND NITRITES 2026-03-05
41 1232B ISOSORBIDE DINITRATE 5MG TAB (ROL) ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 100'S A 116.72 1.1672 TAB 120 BOX ROL ROXANE LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 ORAL 6 NITRATES AND NITRITES
42 1232B ISOSORBIDE DINITRATE 5MG TAB (ROL) ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 100'S A 116.72 1.17 TAB 120 BLIS ROL ROXANE LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2026-04-01 ORAL 6 NITRATES AND NITRITES