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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 B5911 AMLOTENSIVE CT 5MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TABLET 60 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B5911 AMLOTENSIVE CT 5MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.125 TAB 60 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 242892 CCBs, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 CCBs, MISCELLANEOUS
42 B5911 AMLOTENSIVE CT 5MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TAB 60 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 242892 CCBs, MISCELLANEOUS 2026-04-01 ORAL 6 CCBs, MISCELLANEOUS
40 B5921 AMLOTENSIVE CT 5MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.90 0.17 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2024-03-31 Add to Contract as Cat A Oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5921 AMLOTENSIVE CT 5MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.9091 0.171 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
42 B5921 AMLOTENSIVE CT 5MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.91 0.17 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
40 B5931 AMLOTENSIVE CT 10MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2024-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5931 AMLOTENSIVE CT 10MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.259 0.125 TAB 30 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
42 B5931 AMLOTENSIVE CT 10MG|25MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 26.26 0.13 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
40 B5941 AMLOTENSIVE CT 10MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.90 0.17 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-07-11 2022-03-31 Add to Contract as Cat A oral 6 CARDIOVASCULAR DRUGS 2022-07-11
41 B5941 AMLOTENSIVE CT 10MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.9091 0.171 TAB 30 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 IMMUNOSUPPRESSIVE AGENTS
42 B5941 AMLOTENSIVE CT 10MG|50MG TAB (CAR) AMLODIPINE|CHLORTHALIDONE AMLODIPINE|CHLORTHALIDONE AMLOTENSIVE CT 210'S A 35.91 0.17 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 ORAL 6 IMMUNOSUPPRESSIVE AGENTS