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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 20515 DEXTROSE 50% INJ (BRA/COL) DEXTROSE DEXTROSE 50ML B 1.88 1.88 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 20515 DEXTROSE 50% INJ (BRA) DEXTROSE DEXTROSE 50ML B 2.28 2.2834 VIAL 59 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20515 DEXTROSE 50% INJ (BRA) DEXTROSE DEXTROSE 50ML B 3.75 3.75 VIAL 59 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 4020 CALORIC AGENTS 2026-04-01 IV 0 CALORIC AGENTS
40 20523 DEXTROSE 5% INJ (CSC/PHA) DEXTROSE DEXTROSE 250ML B 2.65 2.65 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 20523 DEXTROSE 5% INJ (CSC/PHA) DEXTROSE DEXTROSE 250ML B 3.02 3.02 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 20523 DEXTROSE 5% INJ (CSC) (B) DEXTROSE DEXTROSE 250ML B 2.12 2.1203 BAG 100 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
40 2052F DEXTROSE (2B0062Q) 5% INJ (BAX/STO) DEXTROSE DEXTROSE (2B0062Q) 250ML B 3.32 3.32 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2052F DEXTROSE (2B0062Q) 5% INJ (BAX) (B) DEXTROSE DEXTROSE (2B0062Q) 250ML B 5.93 5.9259 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 2052F DEXTROSE (2B0062Q) 5% INJ (BAX) DEXTROSE DEXTROSE (2B0062Q) 250ML B 4.27 4.27 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2026-04-01 IV 0 CALORIC AGENTS
40 2053A DEXTROSE 5% (CSC/PHA) DEXTROSE DEXTROSE 500ML B 2.50 2.50 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 2053A DEXTROSE 5% (CSC/PHA) DEXTROSE DEXTROSE 500ML B 2.80 2.81 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 2053A DEXTROSE 5% (CSC) PLASTIC BAG (B) DEXTROSE DEXTROSE 500ML B 2.42 2.4193 BAG 100 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
40 2053H DEXTROSE (2B0063Q) 5% (BAX/STO) DEXTROSE DEXTROSE (2B0063Q) 500ML B 2.56 2.56 INJECTION 0 BOTT BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2053H DEXTROSE (2B0063Q) 5% (BAX) (B) DEXTROSE DEXTROSE (2B0063Q) 500ML B 5.49 5.491 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 2053H DEXTROSE (2B0063Q) 5% (BAX) DEXTROSE DEXTROSE (2B0063Q) 500ML B 6.25 6.25 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2026-04-01 IV 0 CALORIC AGENTS
41 20542 DEXTROSE (2B0064X) 5% (BAX) (B) DEXTROSE DEXTROSE (2B0064X) 1 LITRE B 5.76 5.7628 BAG 100 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2024-04-01 2026-03-31 IV 0 CALORIC AGENTS
42 20542 DEXTROSE (2B0064X) 5% (BAX) DEXTROSE DEXTROSE (2B0064X) 1 LITRE B 6.28 6.28 BAG 100 BAG BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 4020 CALORIC AGENTS 2026-04-01 IV 0 CALORIC AGENTS
40 2054C DEXTROSE 5% (CSC/PHA) DEXTROSE DEXTROSE 1 LITRE B 3.95 3.95 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 2054C DEXTROSE 5% (CSC/PHA) DEXTROSE DEXTROSE 1 LITRE B 4.20 4.20 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-06-16 2022-07-18 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 2054C DEXTROSE 5% (CSC/PHA) DEXTROSE DEXTROSE 1 LITRE B 3.98 3.98 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4020 CALORIC AGENTS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18