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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 20821 BEZIDE HS 2.5MG TAB (CAR/COL) BENDROFLUAZIDE BENDROFLUAZIDE BEZIDE HS 500'S A 16.31 0.03 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402820 THIAZIDE DIURETICS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20821 BEZIDE HS 2.5MG TAB (CAR) BENDROFLUAZIDE BENDROFLUAZIDE BEZIDE HS 500'S A 16.31 0.0326 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402820 THIAZIDE DIURETICS 2024-04-01 2026-03-31 ORAL 6 THIAZIDE DIURETICS
42 20821 BEZIDE HS 2.5MG TAB (CAR) BENDROFLUAZIDE BENDROFLUAZIDE BEZIDE HS 500'S A 17.67 0.04 TAB 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS B 402820 THIAZIDE DIURETICS 2026-04-01 ORAL 6 THIAZIDE DIURETICS