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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 5581A HISTAL EXPECTORANT 96MG/ML | 2.5MG/ML SYR (CAR/COL) AMMONIUM CHLORIDE | CHLORPHE More ... AMMONIUM CHLORIDE|CHLORPHENIRAMINE HISTAL EXPECTORANT 2 LITRES B 52.52 0.03 SYRUP 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4816 EXPECTORANTS 2022-05-06 2024-03-31 Add to Contract as Cat B Oral 0 RESPIRATORY TRACT AGENTS 2022-05-06
41 5581A HISTAL EXPECTORANT 96MG/ML|2.5MG/ML SYR (CAR) AMMONIUM CHLOR (B) AMMONIUM CHLORIDE|CHLORPHENIRAMINE HISTAL EXPECTORANT 2 LITRES B 62.52 0.0313 ML 0 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4816 EXPECTORANTS 2024-04-01 2026-03-31 ORAL 0 EXPECTORANTS
42 5581A HISTAL EXPECTORANT 96MG/ML|2.5MG/ML SYR (CAR) AMMONIUM CHLOR AMMONIUM CHLORIDE|CHLORPHENIRAMINE HISTAL EXPECTORANT 2 LITRES B 62.52 0.03 ML 100 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 4816 EXPECTORANTS 2026-04-01 ORAL 0 EXPECTORANTS