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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 1996H SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 3.22 3.22 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2022-07-27 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 1996H SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.53 2.53 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 1996H SODIUM CHLORIDE 0.9% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.42 2.4193 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 19972 SODIUM CHLORIDE (2B1324X) 0.9% INJ (BAX/STO) SODIUM CHLORIDE SODIUM CHLORIDE (2B1324X) 1 LITRE B 2.96 2.96 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 19972 SODIUM CHLORIDE (2B1324X) 0.9% INJ (BAX) (B) SODIUM CHLORIDE SODIUM CHLORIDE (2B1324X) 1 LITRE B 5.03 5.0289 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
42 19972 SODIUM CHLORIDE (2B1324X) 0.9% INJ (BAX) SODIUM CHLORIDE SODIUM CHLORIDE (2B1324X) 1 LITRE B 4.92 4.92 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 IV 0 REPLACEMENT THERAPY
40 1997E SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 2.85 2.85 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 1997E SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 4.82 4.82 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2022-07-18 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 1997E SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 3.79 3.79 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 1997E SODIUM CHLORIDE 0.9% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 3.67 3.6697 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 19985 SODIUM CHLORIDE 0.9% INJ (BRA/COL) SODIUM CHLORIDE SODIUM CHLORIDE 20X10ML B 28.13 1.41 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 19985 SODIUM CHLORIDE 0.9% INJ (BRA) (B) SODIUM CHLORIDE SODIUM CHLORIDE 20X10ML B 6.85 0.3425 VIAL 0 BOX BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
42 19985 SODIUM CHLORIDE 0.9% INJ (BRA) SODIUM CHLORIDE SODIUM CHLORIDE 20X10ML B 11.09 0.55 VIAL 0 BAG BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 IV 0 REPLACEMENT THERAPY
40 19996 SODIUM CHLORIDE (2B1308) 0.9% INJ (BAX/STO) SODIUM CHLORIDE SODIUM CHLORIDE (2B1308) 16X50ML B 40.15 2.51 INJECTION 0 VIAL BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 19996 SODIUM CHLORIDE (2B1308) 0.9% INJ (BAX) (B) SODIUM CHLORIDE SODIUM CHLORIDE (2B1308) 16X50ML B 74.29 4.6432 VIAL 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
42 19996 SODIUM CHLORIDE (2B1308) 0.9% INJ (BAX) SODIUM CHLORIDE SODIUM CHLORIDE (2B1308) 16X50ML B 63.91 3.99 VIAL 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 IV 0 REPLACEMENT THERAPY
40 199C1 SODIUM CHLORIDE 5% INJ (BAX/STO) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 8.32 8.32 INJECTION 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 199C1 SODIUM CHLORIDE 5% INJ (BAX) SODIUM CHLORIDE SODIUM CHLORIDE 500ML BQ 11.0908 11.0908 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 199E1 SODIUM CHLORIDE 3% INJ (BAX/STO) SODIUM CHLORIDE SODIUM CHLORIDE 500ML BQ 4.16 4.16 INJECTION 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4036 IRRIGATING SOLUTIONS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 199E1 SODIUM CHLORIDE 3% INJ (BAX) SODIUM CHLORIDE SODIUM CHLORIDE 500ML BQ 5.3823 5.3823 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY