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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 6031P GYNOLAX 50MG TAB (ABB/PHA) CLOMIPHENE CLOMIPHENE GYNOLAX 10'S C 5.74 0.57 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 681612 ESTROGEN AGONIST-ANTAGONIST 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 6031P GYNOLAX 50MG TAB (ABB/PHA) CLOMIPHENE (C) CLOMIPHENE GYNOLAX 10'S C 5.74 0.574 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 681612 ESTROGEN AGONIST-ANTAGONIST 2022-04-01 2023-03-31 Delete from contract Oral 0 ESTROGEN AGONIST-ANTAGONIST 2023-03-02
40 6031Q REJUN 50MG TAB (SGL/AHI) CLOMIPHENE CLOMIPHENE REJUN 10'S C 4.21 0.42 TABLET 0 TAB SGL STERIL-GENE LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 681612 ESTROGEN AGONIST-ANTAGONIST 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 6031R REJUN 50MG TAB (TMP) CLOMIPHENE CLOMIPHENE REJUN 10'S C 4.29 0.4295 TAB 0 BOX TMP THE MADRAS PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 681612 ESTROGEN AGONIST-ANTAGONIST 2024-04-01 2026-03-31 ORAL 0 ESTROGEN AGONIST-ANTAGONIST
42 6031S FERTOMID 50MG TAB (CIP) CLOMIPHENE (C) CLOMIPHENE FERTOMID 500'S C 268.49 0.54 TAB 0 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 681612 ESTROGEN AGONIST-ANTAGONIST 2026-04-01 ORAL 0 ESTROGEN AGONIST-ANTAGONIST