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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 B041JL NEXIUM 20MG TAB (AZN/COL) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 41.59 1.49 TABLET 0 TAB AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
41 B041JL NEXIUM 20MG TAB (AZN) ESOMEPRAZOLE (C) ESOMEPRAZOLE NEXIUM 28'S C 40.67 1.4524 TAB 0 BOX AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 ORAL 0 PROTON PUMP INHIBITORS
42 B041JL NEXIUM 20MG TAB (AZN) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 40.77 1.46 TAB 0 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 562836 PROTON PUMP INHIBITORS 2026-04-01 ORAL 0 PROTON PUMP INHIBITORS
40 B041JM NEXIUM 40MG TAB (AZN/COL) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 52.25 1.87 TABLET 0 TAB AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
41 B041JM NEXIUM 40MG TAB (AZN) ESOMEPRAZOLE (C) ESOMEPRAZOLE NEXIUM 28'S C 52.25 1.8659 TAB 0 BOX AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 ORAL 0 PROTON PUMP INHIBITORS
42 B041JM NEXIUM 40MG TAB (AZN) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 55.05 1.97 TAB 0 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 562836 PROTON PUMP INHIBITORS 2026-04-01 ORAL 0 PROTON PUMP INHIBITORS
40 B041LE NEXIUM 10MG GRAN (AZN/COL) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 47.71 1.70 GRANULES 0 TAB AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
42 B041LE NEXIUM 10MG GRAN (AZN) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 28'S C 47.84 1.71 TAB 0 BLIS AZN ASTRAZENECA AB COL AVENTA BARBADOS 562836 PROTON PUMP INHIBITORS 2026-04-01 ORAL 0 PROTON PUMP INHIBITORS
40 B041LG ESOMEPRAZOLE 20MG TAB (KWA/ATB) ESOMEPRAZOLE ESOMEPRAZOLE 10X10 C 19.03 0.19 TABLET 0 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 Oral 0 GASTROINTESTINAL DRUGS
40 B041LQ EMEP 40MG CAP (ARP/AHI) ESOMEPRAZOLE ESOMEPRAZOLE EMEP 40'S C 16.36 0.41 CAPSULE 0 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 Add to Contract as Cat C Oral 0 GASTROINTESTINAL DRUGS 2022-03-10
41 B041PD ESOMAC 20MG TAB (MPI) ESOMEPRAZOLE (C) ESOMEPRAZOLE ESOMAC 3X10 C 3.62 0.1205 TAB 0 BOX MPI MEPRO PHARMACEUTICALS INTERNATIONAL LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 ORAL 0 PROTON PUMP INHIBITORS
41 B041PE ESOMAC 40MG TAB (MPI) ESOMEPRAZOLE (C) ESOMEPRAZOLE ESOMAC 3X10 C 4.19 0.1395 TAB 0 BOX MPI MEPRO PHARMACEUTICALS INTERNATIONAL LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 ORAL 0 PROTON PUMP INHIBITORS
40 B042AP NEXIUM 40MG INJ (AZN/COL) ESOMEPRAZOLE ESOMEPRAZOLE NEXIUM 10X5ML C 146.79 14.68 INJECTION 0 VIAL AZN ASTRAZENECA AB COL COLLINS LTD 562836 PROTON PUMP INHIBITORS 2022-04-01 2022-06-15 Delete from contract IV 0 GASTROINTESTINAL DRUGS 2022-05-04
40 B042AW EMEP 40MG INJ (ARP/AHI) ESOMEPRAZOLE ESOMEPRAZOLE EMEP 40MG VIAL C 7.94 7.94 INJECTION 0 VIAL ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2022-04-01 2024-03-31 IV 0 GASTROINTESTINAL DRUGS
41 B042AW EMEP 40MG INJ (ARP) ESOMEPRAZOLE (C) ESOMEPRAZOLE EMEP 40MG VIAL C 5.44 5.4366 VIAL 0 VIAL ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 562836 PROTON PUMP INHIBITORS 2024-04-01 2026-03-31 IV 0 PROTON PUMP INHIBITORS