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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 22814 ACETAZOLAMIDE 250MG TAB (REM/SBI) ACETAZOLAMIDE ACETAZOLAMIDE 1000's A 84.43 0.08 TABLET 120 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 22814 ACETAZOLAMIDE 250MG TAB (REM) ACETAZOLAMIDE ACETAZOLAMIDE 1000'S A 107.4 0.1074 TAB 120 BOTT REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 CARBONIC ANHYDRASE INHIBITORS
42 22814 ACETAZOLAMIDE 250MG TAB (REM) ACETAZOLAMIDE ACETAZOLAMIDE 1000'S A 105.74 0.11 TAB 120 BOTT REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 ORAL 6 CARBONIC ANHYDRASE INHIBITORS
40 22819 ACETAZOLAMIDE 250MG TAB (KWA/ATB) ACETAZOLAMIDE ACETAZOLAMIDE 10X10 A 80.79 0.08 TABLET 120 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-03-30
40 2281AA ACETAZOLAMIDE 250MG TAB (FSB/ATB) ACETAZOLAMIDE ACETAZOLAMIDE 10X10 A 7.20 0.07 TABLET 120 TAB FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2281AS APO-ACETAZOLAMIDE 250MG TAB (APO) ACETAZOLAMIDE APO-ACETAZOLAMIDE 100'S A 12.01 0.1202 TAB 120 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 CARBONIC ANHYDRASE INHIBITORS
42 2281AU ACETAZOLAMIDE 250MG TAB (FSB) ACETAZOLAMIDE ACETAZOLAMIDE 1000'S A 55.54 0.06 TAB 120 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 Add to Contract as Cat A ORAL 6 CARBONIC ANHYDRASE INHIBITORS 2026-03-05
42 2281U ACEMIDE 250MG TAB (JLP) ACETAZOLAMIDE ACETAZOLAMIDE ACEMIDE 100'S A 8.16 0.08 TAB 120 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC B 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 ORAL 6 CARBONIC ANHYDRASE INHIBITORS
40 22826 ACETAZOLAMIDE 500MG INJ (XGE/AHI) ACETAZOLAMIDE ACETAZOLAMIDE 1DOSE SYRN BQ 165.44 165.44 INJECTION 0 PFS XGE X-GEN PHARMACEUTICALS INC AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2022-09-30 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-03-29
40 22827 ACETAZOLAMIDE 500MG INJ (MAT/AHI) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 182.67 182.67 INJECTION 0 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 22827 ACETAZOLAMIDE 500MG INJ (MAT) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 182.89 182.8888 VIAL 10 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 IV 6 CARBONIC ANHYDRASE INHIBITORS
42 22827 ACETAZOLAMIDE 500MG INJ (MAT) ACETAZOLAMIDE ACETAZOLAMIDE 500MG VIAL BQ 189.39 189.39 VIAL 10 VIAL MAT MYLAN LABORATORIES AHI ARMSTRONG HEALTHCARE INC 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 IV 0 CARBONIC ANHYDRASE INHIBITORS
40 22832 ACETAZOLAMIDE SR 250MG TAB (CHC/ATB) ACETAZOLAMIDE SR ACETAZOLAMIDE SR 100'S A 154.75 1.55 TABLET 60 TAB CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD B 402804 CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE