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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 199E1 SODIUM CHLORIDE 3% INJ (BAX) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 11.47 11.47 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 2002A SODIUM LACTATE CO. INJ (CSC/PHA) SODIUM LACTATE CO. SODIUM LACTATE CO. 500ML B 2.50 2.50 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 2002A SODIUM LACTATE CO. INJ (CSC/PHA) SODIUM LACTATE CO. SODIUM LACTATE CO. 500ML B 3.35 3.35 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 2002A SODIUM LACTATE CO. INJ (CSC) (B) SODIUM LACTATE CO. SODIUM LACTATE CO. 500ML B 2.42 2.4193 BAG 70 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2024-04-01 2026-03-31 IV 0 ALKALINIZING AGENTS
40 2002F SODIUM LACTATE (2B2323Q) 2.7MEQ/L | 1 INJ (BAX/STO) SODIUM LACTATE CO. SODIUM LACTATE CO. SODIUM LACTATE (2B2323Q) 500ML B 2.47 2.47 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2002F SODIUM LACTATE CO. (2B2323Q) INJ (BAX) (B) CALCIUM|CHLORIDE|LACTATE|POTASSIUM|SODIUM SODIUM LACTATE (2B2323Q) 500ML B 5.03 5.0289 BAG 0 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2024-04-01 2026-03-31 IV 0 ALKALINIZING AGENTS
42 2002F SODIUM LACTATE (2B2323Q) INJ (BAX) SODIUM LACTATE CO. SODIUM LACTATE (2B2323Q) 500ML B 6.25 6.25 BAG 70 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2026-04-01 2028-03-31 IV 0 ALKALINIZING AGENTS
40 20032 SODIUM LACTATE (2B2324X) INJ (BAX/STO) SODIUM LACTATE CO. SODIUM LACTATE CO. SODIUM LACTATE (2B2324X) 1 LITRE B 2.69 2.69 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20032 SODIUM LACTATE (2B2324X) INJ (BAX) SODIUM LACTATE CO. (B) SODIUM LACTATE CO. SODIUM LACTATE (2B2324X) 1 LITRE B 5.55 5.5454 BOTT 70 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2024-04-01 2026-03-31 IV 0 ALKALINIZING AGENTS
42 20032 SODIUM LACTATE (2B2324X) INJ (BAX) SODIUM LACTATE CO. SODIUM LACTATE CO. SODIUM LACTATE (2B2324X) 1 LITRE B 5.57 5.57 BAG 70 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4008 ALKALINIZING AGENTS 2026-04-01 2028-03-31 IV 0 ALKALINIZING AGENTS
40 2003B SODIUM LACTATE INJ (CSC/PHA) SODIUM LACTATE CO. SODIUM LACTATE 1 LITRE B 2.75 2.75 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2022-04-01 2022-06-15 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 2003B SODIUM LACTATE INJ (CSC/PHA) SODIUM LACTATE CO. SODIUM LACTATE 1 LITRE B 6.70 6.70 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2022-06-16 2022-07-18 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 2003B SODIUM LACTATE INJ (CSC/PHA) SODIUM LACTATE CO. SODIUM LACTATE 1 LITRE B 3.56 3.56 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 2003B SODIUM LACTATE CO. INJ (CSC) (B) SODIUM LACTATE CO. SODIUM LACTATE CO. 1 LITRE B 3.53 3.5338 BAG 70 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4008 ALKALINIZING AGENTS 2024-04-01 2026-03-31 IV 0 ALKALINIZING AGENTS
40 20116 POTASSIUM CHLORIDE 600MG TAB (KWA/ATB) POTASSIUM CHLORIDE POTASSIUM CHLORIDE 10X10 A 62.52 0.63 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20117 POTASSIUM CHLORIDE 600MG SR TAB (LDP) POTASSIUM CHLORIDE POTASSIUM 100'S A 59.67 0.5967 TABSR 120 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 ORAL 6 REPLACEMENT THERAPY
42 20117 POTASSIUM CHLORIDE 600MG SR TAB (LDP) POTASSIUM CHLORIDE POTASSIUM CHLORIDE 100'S A 59.67 0.60 TAB 120 BLIS LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 ORAL 6 REPLACEMENT THERAPY
40 2012L POTASSIUM CHLORIDE 2MEQ/ML INJ (BRA/COL) POTASSIUM CHLORIDE POTASSIUM CHLORIDE 20X10ML B 13.08 0.65 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4012 REPLACEMENT THERAPY 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2012L POTASSIUM CHLORIDE 2MEQ/ML INJ (BRA) (B) POTASSIUM CHLORIDE POTASSIUM CHLORIDE 20X10ML B 13.08 0.6538 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 2012L POTASSIUM CHLORIDE 2MEQ/ML INJ (BRA) POTASSIUM CHLORIDE POTASSIUM CHLORIDE 20X10ML B 31.32 1.57 VIAL 0 AMP BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 IV 0 REPLACEMENT THERAPY