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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 2012V POTASSIUM CHLORIDE 2MEQ/ML INJ (MON POTASSIUM CHLORIDE POTASSIUM CHLORIDE 5X10ML B 7.50 1.50 AMPG 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2026-04-01 2028-03-31 IV 0 REPLACEMENT THERAPY
41 2012X POTASSIUM CHLORIDE 2MEQ/ML INJ (FSB) (B) POTASSIUM CHLORIDE POTASSIUM 5X10ML B 5.71 1.142 AMP 0 BOX FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 0 REPLACEMENT THERAPY 2024-01-26
42 20313 K BIND 15G PWDR (SLS) CALCIUM POLYSTYRENE SULPHONATE CALCIUM POLYSTYRENE SULPHONATE K BIND 20'S BQ 181.39 9.07 SACH 20 SACH SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 401818 POTASSIUM-REMOVING AGENTS 2026-04-01 2028-03-31 ORAL 0 POTASSIUM-REMOVING AGENTS
40 20317 CALCIUM POLYSTYRENE SULPHONATE PWDR (SLS/AHI CALCIUM POLYSTYRENE SULPHONATE CALCIUM POLYSTYRENE SULPHONATE 300G A 159.76 159.76 POWDER 1 CAN SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 401818 POTASSIUM-REMOVING AGENTS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 20413 AMINOPLASMAL E 10% SOLN (BRA/COL) AMINO ACID AMINO ACID AMINOPLASMAL E 500ML BQ 15.20 15.20 INJECTION 0 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20413 AMINOPLASMAL E 10% (BRA) AMINO ACID (BQ) AMINO ACID AMINOPLASMAL E 500ML BQ 16.45 16.4459 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20413 AMINOPLASMAL E 10% (BRA) AMINO ACID AMINO ACID AMINOPLASMAL E 500ML BQ 24.46 24.46 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 20425 AMINOPLASMAL E 5% SOLN (BRA/COL) AMINO ACID AMINO ACID AMINOPLASMAL E 500ML BQ 13.75 13.75 INJECTION 0 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20425 AMINOPLASMAL E 5% (BRA) AMINO ACID (BQ) AMINO ACID AMINOPLASMAL E 500ML BQ 14.35 14.3528 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20425 AMINOPLASMAL E 5% (BRA) AMINO ACID AMINO ACID AMINOPLASMAL E 500ML BQ 19.57 19.57 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 20443 AMINOPLASMAL W | O ELECTROLYTES 15% INJ (BRA/COL) AMINO ACID AMINO ACID AMINOPLASMAL W|O ELECTROLYTES 500ML BQ 26.45 26.45 INJECTION 0 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20443 AMINOPLASMAL W|O ELECTROLYTES 15% INJ (BRA) AMINO ACID (BQ) AMINO ACID AMINOPLASMAL W|O ELECTROLYTES 500ML BQ 28.19 28.189 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20443 AMINOPLASMAL W|O ELECTROLYTES 15% INJ (BRA) AMINO ACID AMINO ACID AMINOPLASMAL W|O ELECTROLYTES 500ML BQ 48.93 48.93 BOTT 100 BOTT BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 20515 DEXTROSE 50% INJ (BRA/COL) DEXTROSE DEXTROSE 50ML B 1.88 1.88 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20515 DEXTROSE 50% INJ (BRA) DEXTROSE DEXTROSE 50ML B 2.28 2.2834 VIAL 59 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20515 DEXTROSE 50% INJ (BRA) DEXTROSE DEXTROSE 50ML B 3.75 3.75 VIAL 59 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4020 CALORIC AGENTS 2026-04-01 2028-03-31 IV 0 CALORIC AGENTS
40 20523 DEXTROSE 5% INJ (CSC/PHA) DEXTROSE DEXTROSE 250ML B 2.65 2.65 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 20523 DEXTROSE 5% INJ (CSC/PHA) DEXTROSE DEXTROSE 250ML B 3.02 3.02 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 20523 DEXTROSE 5% INJ (CSC) (B) DEXTROSE DEXTROSE 250ML B 2.12 2.1203 BAG 100 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
40 2052F DEXTROSE (2B0062Q) 5% INJ (BAX/STO) DEXTROSE DEXTROSE (2B0062Q) 250ML B 3.32 3.32 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE