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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
41 A661BD APO-ELETRIPTAN 40MG TAB (APO) (C) ELETRIPTAN HYDROBROMIDE APO-ELETRIPTAN 6'S C 22.18 3.6969 TAB 0 BOX APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD 1216 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS 2024-04-01 2026-03-31 ORAL 0 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS
40 A661D RELPAX 40MG TAB (PFI/STO) ELETRIPTAN HBR ELETRIPTAN HYDROBROMIDE RELPAX 2'S C 23.98 11.99 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 283228 SELECTIVE SEROTONIN AGONIST 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 A661D RELPAX 40MG TAB (PFI) ELETRIPTAN HBR (C) ELETRIPTAN HYDROBROMIDE RELPAX 2'S C 24.19 12.0966 TAB 0 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 283228 SELECTIVE SEROTONIN AGONIST 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN AGONIST
40 A661R RELPAX 40MG TAB (PFI/SBI) ELETRIPTAN HBR ELETRIPTAN HYDROBROMIDE RELPAX 2'S C 23.98 11.99 TABLET 0 TAB PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 283228 SELECTIVE SEROTONIN AGONIST 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 A661R RELPAX 40MG TAB (PFI) ELETRIPTAN HBR (C) ELETRIPTAN HYDROBROMIDE RELPAX 2'S C 24.19 12.0966 TAB 0 BOX PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 283228 SELECTIVE SEROTONIN AGONIST 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN AGONIST