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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 0102AA NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-01-26
42 0102AB NYSTATIN 100,000U/ML SUSP (FSB) NYSTATIN NYSTATIN 60ML A 5.14 0.09 ML 180 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-03-05
42 0102AC NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-02-26
40 0102T PMS-NYSTATIN 100,000U/ML SUSP (PMS/COL) NYSTATIN PMS-NYSTATIN 100ML A 6.80 0.07 SUSPENSION 180 ML PMS PHARMASCIENCE COL COLLINS LTD 081428 POLYENES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0102T PMS-NYSTATIN 100,000U/ML SUSP (PMS) NYSTATIN PMS-NYSTATIN 100ML A 8.15 0.0816 ML 180 BOTT PMS PHARMASCIENCE COL COLLINS LTD 081428 POLYENES 2024-04-01 2026-03-31 ORAL 0 POLYENES
40 0102V NYSTATIN 100,000U/ML SUSP (HEA/ATB) NYSTATIN NYSTATIN 60ML A 5.71 0.0952 SUSPENSION HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 81428 POLYENES 2022-12-07 2024-03-31 Change Local Agent ORAL 0 POLYENES 2022-11-25
41 0102V NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.76 0.096 ML 180 BOTT HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 081428 POLYENES 2024-04-01 2026-03-31 ORAL 0 POLYENES
42 0102Z NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 081428 POLYENES 2026-04-01 Price Change ORAL 0 POLYENES 2025-10-31
40 0111D CEFUROXIME 500MG CAP (KWA/ATB) CEFUROXIME CEFUROXIME 100'S BQ 66.95 0.67 CAPSULE 0 CAP KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
40 0111DL CEFADROXIL 500MG CAP (KWA/ATB) CEFADROXIL CEFADROXIL 10X10 A 23.11 0.23 CAPSULE 28 CAP KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 08120604 FIRST GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0111FA ADORA 500MG CAP (INC) CEFADROXIL CEFADROXIL ADORA 20'S A 8.07 0.4037 CAP 28 BOX INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 08120604 FIRST GEN CEPHALOSPORINS 2024-04-01 2026-03-31 ORAL 0 FIRST GEN CEPHALOSPORINS
42 0111FA ADORA 500MG CAP (INC) CEFADROXIL CEFADROXIL ADORA 20'S A 8.26 0.41 CAP 28 BLIS INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 08120604 FIRST GEN CEPHALOSPORINS 2026-04-01 ORAL 0 FIRST GEN CEPHALOSPORINS
41 0111FB BACTERAM 500MG TAB (MBL) CEFADROXIL CEFADROXIL BACTERAM 12'S A 5.11 0.4259 TAB 28 BOX MBL MEDICAMEN BIOTECH LTD AHI ARMSTRONG HEALTHCARE INC 08120604 FIRST GEN CEPHALOSPORINS 2024-04-01 2026-03-31 ORAL 0 FIRST GEN CEPHALOSPORINS
41 0111FD ZINNAT 500MG TAB (BCH) CEFUROXIME CEFUROXIME ZINNAT 50'S BQ 64.91 1.2982 TAB 20 BOX BCH SANDOZ COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2024-04-01 2026-03-31 ORAL 0 SECOND GEN CEPHALOSPORINS 2023-08-10
42 0111FD ZINNAT 500MG TAB (BCH) CEFUROXIME CEFUROXIME ZINNAT 50'S C 86.33 1.73 TAB 20 BLIS BCH SANDOZ COL AVENTA BARBADOS 08120608 SECOND GEN CEPHALOSPORINS 2026-04-01 ORAL 0 SECOND GEN CEPHALOSPORINS
41 0111FE ZINNAT 500MG TAB (BCH) CEFUROXIME CEFUROXIME ZINNAT 10'S BQ 12.98 1.298 TAB 20 BLIS BCH SANDOZ COL COLLINS LTD 08120604 FIRST GEN CEPHALOSPORINS 2024-08-23 2026-09-05 ORAL 0 FIRST GEN CEPHALOSPORINS 2024-08-23
41 0111FE ZINNAT 500MG TAB (BCH) CEFUROXIME CEFUROXIME ZINNAT 10'S BH 12.98 1.298 TAB 20 BLIS BCH SANDOZ COL COLLINS LTD 08120604 FIRST GEN CEPHALOSPORINS 2024-09-06 2026-03-31 ORAL 0 FIRST GEN CEPHALOSPORINS 2024-09-06
42 0111FJ XORICEF 500MG TAB (JLP) CEFUROXIME CEFUROXIME XORICEF 10X10 BH 51.65 0.52 TAB 20 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 08120604 FIRST GEN CEPHALOSPORINS 2026-04-01 ORAL 0 FIRST GEN CEPHALOSPORINS
40 0111S ZINNAT 500MG TAB (GSK/COL) CEFUROXIME CEFUROXIME ZINNAT 50'S C 145.62 2.91 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0112BB CEFADROXIL MK 50MG/ML SUSP (BON/COL) CEFADROX CEFADROXIL CEFADROXIL MK 60ML A 8.54 0.14 SUSPENSION 120 ML BON CORPORACION BONIMA COL COLLINS LTD 08120604 FIRST GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS