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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 25718 BETACORT 0.1% OINT (CAR) BETAMETHASONE BETAMETHASONE BETACORT 15G A 4.62 4.62 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 25737 BETACORT 0.1% CR (CAR/COL) BETAMETHASONE BETAMETHASONE BETACORT 15G A 4.62 4.62 CREAM 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 25737 BETACORT 0.1% CR (CAR) BETAMETHASONE (C) BETAMETHASONE BETACORT 15G C 4.62 4.6212 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 25737 BETACORT 0.1% CR (CAR) BETAMETHASONE BETAMETHASONE BETACORT 15G A 4.62 4.62 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
41 2573E BETAMETHASONE 0.1% CR (GPC) BETAMETHASONE BETAMETHASONE 15G A 2.34 2.3378 TUBE 2 BOX GPC NEW GUYANA PHARMACEUTICAL CORP. LTD ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 2573V BETNOVATE 0.1% CR (GSK/COL) BETAMETHASONE BETAMETHASONE BETNOVATE 30G C 14.57 14.57 CREAM 0 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 2573V BETNOVATE 0.1% CR (GSK) BETAMETHASONE (C) BETAMETHASONE BETNOVATE 30G C 15.68 15.6847 TUBE 2 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 2573V BETNOVATE 0.1% CR (GSK) BETAMETHASONE BETAMETHASONE BETNOVATE 30G C 16.47 16.47 TUBE 2 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 2592AD FAMOTIDINE 10MG/ML INJ (DIL/AHI) FAMOTIDINE FAMOTIDINE 25X2ML B 120.97 4.84 INJECTION 0 AMP DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 IV 0 GASTROINTESTINAL DRUGS
41 2592AJ LADINE 10MG/ML INJ (LDP) FAMOTIDINE FAMOTIDINE LADINE 10X2ML B 52.03 5.2029 AMP 0 BOX LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2024-04-01 2026-03-31 IV 0 HISTAMINE RECEPTOR ANTAGONIST
42 2592AM FAMOTIDINE 10MG/ML INJ (MAT) FAMOTIDINE FAMOTIDINE 25X2 ML BQ 129.80 5.19 AMPG 0 AMP MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 IV 0 HISTAMINE RECEPTOR ANTAGONIST
40 2593AD APO-SUCRALFATE 1G TAB (APO/COL) SUCRALFATE APO-SUCRALFATE 100'S A 45.72 0.46 TABLET 120 TAB APO APOTEX INC. COL COLLINS LTD 562832 GI PROTECTANTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
40 2593DR FAMOTIDINE 20MG TAB (APL/AHI) FAMOTIDINE FAMOTIDINE 100'S C 24.85 0.25 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
42 2593DU SUCRALFATE 1G TAB (MAT) SUCRALFATE SUCRALFATE 100'S A 83.81 0.84 TAB 120 BOTT MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 562832 GI PROTECTANTS 2026-04-01 2028-03-31 ORAL 6 GI PROTECTANTS
40 2594AL FAMOPSIN 40MG TAB (REM/SBI) FAMOTIDINE FAMOTIDINE FAMOPSIN 10X10 A 6.90 0.07 TABLET 30 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 562812 HISTAMINE RECEPTOR ANTAGONIST 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
41 2594AL FAMOPSIN 40MG TAB (REM) FAMOTIDINE FAMOTIDINE FAMOPSIN 10X10 A 6.52 0.0652 TAB 30 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 562812 HISTAMINE RECEPTOR ANTAGONIST 2024-04-01 2026-03-31 ORAL 6 HISTAMINE RECEPTOR ANTAGONIST
42 2594AL FAMOPSIN 40MG TAB (REM) FAMOTIDINE FAMOTIDINE FAMOPSIN 10X10 B 12.80 0.13 TAB 30 BLIS REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 562812 HISTAMINE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 HISTAMINE RECEPTOR ANTAGONIST
42 2594C FAMOTIDINE 40MG TAB (ZYP) FAMOTIDINE FAMOTIDINE 3X10 A 1.28 0.04 TAB 30 BLIS ZYP ZYPHAR'S PHARMACEUTICAL Pvt Ltd RXP RX PRO INC 562812 HISTAMINE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 HISTAMINE RECEPTOR ANTAGONIST
42 2594EJ FOMODIN 40MG TAB (ANC) FAMOTIDINE FAMOTIDINE FOMODIN 10X10 A 4.89 0.05 TAB 30 BLIS ANC AEONIM HEALTHCARE SBI MASSY DISTRIBUTION (BDOS) LTD 562812 HISTAMINE RECEPTOR ANTAGONIST 2026-04-01 2028-03-31 ORAL 6 HISTAMINE RECEPTOR ANTAGONIST 2026-02-11
40 26416 FLIXOTIDE 50MCG INHR (GSK/COL) FLUTICASONE FLUTICASONE FLIXOTIDE 120 DOSES A 21.67 21.67 INHALER 1 INHR GSK GLAXOSMITHKLINE COL COLLINS LTD B 481008 CORTICOSTEROIDS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS