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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 76219 FEMIANE 20MCG | 75MCG TAB (BSP/AHI) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE FEMIANE 21'S C 14.41 14.41 TABLET 0 PACK BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621AZ CICLOTAB 20MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621AZ CICLOTAB 20MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-02
40 7621BB CICLOTAB 30MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET 0 PACK ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7621BB CICLOTAB 30MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) ETHINYL ESTRADIOL|GESTODENE CICLOTAB 21'S C 15.98 15.98 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2023-03-31 Delete from contract Oral 0 CONTRACEPTIVES 2023-03-07
41 7621BV LINDYNETTE 20MCG|75MCG TAB (CHW) ETHINYL ESTRADIOL|GESTODENE (C) ETHINYL ESTRADIOL|GESTODENE LINDYNETTE 21'S C 4.1 4.1047 PACK 0 BOX CHW CHEMICAL WORKS OF GEDEON RICHTER LTD AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
40 7621G FEMIANE 20MCG | 75MCG TAB (BSP/COL) ETHINYLESTRADIOL | GESTODENE ETHINYL ESTRADIOL|GESTODENE FEMIANE 21'S C 14.41 14.41 TABLET 0 PACK BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES