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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 0411J CHLOROQUINE SULPHATE 250MG TAB (HEA/RXP) CHLOROQUINE SULPHATE CHLOROQUINE SULPHATE 40'S A 24.33 0.61 TABLET 90 TAB HEA HEALTH 2000 INC RXP RX PRO INC 083008 ANTIMALARIALS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
40 0411K CHLOROQUINE SULPHATE 250MG TAB (HEA/ATB) CHLOROQUINE SULPHATE CHLOROQUINE SULPHATE 40'S A 24.33 0.6082 TABLET IMMED 90 HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 83008 ANTIMALARIALS 2022-07-12 la oral 6 ANTIMALARIALS
40 0411K CHLOROQUINE SULPHATE 250MG TAB (HEA/ATB) CHLOROQUINE SULPHATE CHLOROQUINE SULPHATE 40'S A 24.33 0.6082 TABLET IMMED HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 83008 ANTIMALARIALS 2022-12-07 2024-03-31 Change Local Agent oral 6 ANTIMALARIALS 2022-11-25