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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 0071H
41 0071H APO-ZOLPIDEM 5MG TAB (APO/ATB) ZOLPIDEM APO-ZOLPIDEM 30'S C 18.16 0.6053 TAB 0 TAB APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS ORAL 0 CENTRAL NERVOUS SYSTEM DRUGS
41 0072D
41 0072D ZOLPIDEM 10MG TAB (RYV/ALW) ZOLPIDEM ZOLPIDEM 30'S C 18.62 0.6207 TAB 0 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS ORAL 0 CENTRAL NERVOUS SYSTEM DRUGS
40 0072D ZOLPIDEM 10MG TAB (RYV/ALW) ZOLPIDEM ZOLPIDEM 30'S C 18.62 0.62 TABLET 0 TAB RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 0072E
41 0072E APO-ZOLPIDEM 10MG TAB (APO/ATB) ZOLPIDEM APO-ZOLPIDEM 30'S C 20.39 0.6796 TAB 0 TAB APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS ORAL 0 CENTRAL NERVOUS SYSTEM DRUGS
40 0072K APO-ZOLPIDEM 10MG TAB (APO/COL) ZOLPIDEM APO-ZOLPIDEM 30'S C 19.98 0.67 TABLET 0 TAB APO APOTEX INC. COL COLLINS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 0081AG AMPHOTIN 50MG INJ (UBI/RXP) AMPHOTERICIN B AMPHOTERICIN B AMPHOTIN 50MG VIAL BQ 19.71 19.71 INJECTION 0 VIAL UBI UNITED BIOTECH (P) LIMITED RXP RX PRO INC 081428 POLYENES 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
40 0081AJ AMPHIZOME 50MG INJ (FSB/ATB) AMPHOTERICIN B AMPHOTERICIN B AMPHIZOME 5ML BQ 24.46 24.46 INJECTION 0 VIAL FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 081428 POLYENES 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
41 0081T
41 0081T FLUCONAZOLE 200MG INJ (BRA/COL) FLUCONAZOLE FLUCONAZOLE 100ML BQ 4.92 4.9202 INJ 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 081408 AZOLES IV 0 ANTI-INFECTIVE AGENTS
40 0081T FLUCONAZOLE 200MG INJ (BRA/COL) FLUCONAZOLE FLUCONAZOLE 100ML BQ 4.65 4.65 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 081408 AZOLES 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
41 00915 GRISEOFULVIN 125MG TAB (REM/SBI) GRISEOFULVIN GRISEOFULVIN 10x10 A 14.08 0.1408 TAB 60 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081492 ANTIFUNGALS, MISCELLANEOUS ORAL 6 ANTI-INFECTIVE AGENTS
40 00915 GRISEOFULVIN 125MG TAB (REM/SBI) GRISEOFULVIN GRISEOFULVIN 10x10 A 17.37 0.17 TABLET 60 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
41 00923 GRISEOFULVIN 500MG TAB (REM/SBI) GRISEOFULVIN GRISEOFULVIN 10X10 A 27.43 0.2743 TAB 60 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081492 ANTIFUNGALS, MISCELLANEOUS ORAL 6 ANTI-INFECTIVE AGENTS
40 00923 GRISEOFULVIN 500MG TAB (REM/SBI) GRISEOFULVIN GRISEOFULVIN 10X10 A 28.27 0.28 TABLET 60 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
41 00939 GRISEOFULVIN 25MG/ML SUSP (SUE/AHI) GRISEOFULVIN GRISEOFULVIN 120ML A 15.71 0.1309 SUSP 500 ML SUE LABORATORIOS SUED S.R.L AHI ARMSTRONG HEALTHCARE INC 081492 ANTIFUNGALS, MISCELLANEOUS ORAL 6 ANTI-INFECTIVE AGENTS
40 00939 GRISEOFULVIN 25MG/ML SUSP (SUE/AHI) GRISEOFULVIN GRISEOFULVIN 120ML A 14.87 0.12 SUSPENSION 500 ML SUE LABORATORIOS SUED S.R.L AHI ARMSTRONG HEALTHCARE INC 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
40 0093A FLUVIN 25MG/ML SUSP (RYV/ALW) GRISEOFULVIN GRISEOFULVIN FLUVIN 100ML A 12.21 0.12 SUSPENSION 500 ML RYV RYVIS PHARMA PVT. LTD ALW ALTIMAR WHOLESALERS INC 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS