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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 B4511 NATRIXAM 5MG | 1.5MG TAB (SER/STO) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4511 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) A (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4512 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 B4513 NATRIXAM 5MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.18 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-05-01
41 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AM (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4513 NATRIXAM 5MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 B4514 NATRIXAM 10MG | 1.5MG TAB (SER/COL) AMLODIPINE | INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.31 0.24 TABLET 30 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 B4514 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.2465 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2024-05-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-30
41 B4514 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE (C) AMLODIPINE|INDAPAMIDE NATRIXAM 30'S C 7.39 0.2463 TABMR 30 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-06-01
42 B4514 NATRIXAM 10MG|1.5MG MR TAB (SER) AMLODIPINE|INDAPAMIDE AMLODIPINE|INDAPAMIDE NATRIXAM 30'S A 7.39 0.25 TAB 30 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
41 B451E AMLODIPINE/INDAPAMIDE 10MG|1.5MG MR TAB (HEA) AMLODIPINE|IND AMLODIPINE|INDAPAMIDE AMLODIPINE/INDAPAMIDE 3X10 A 3.72 0.124 TABMR 30 BOX HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09
41 B451F AMLODIPINE/INDAPAMIDE 5MG|1.5MG MR TAB (HEA) AMLODIPINE|INDA AMLODIPINE|INDAPAMIDE AMLODIPINE/INDAPAMIDE 3X10 A 3.64 0.1213 TABMR 30 BOX HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-09