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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 11613 HYDRALLAZINE 25MG TAB (REM/SBI) HYDRALLAZINE HYDRALLAZINE 10X10 A 6.28 0.06 TABLET 120 TAB REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 11613 HYDRALLAZINE 25MG TAB (REM) HYDRALLAZINE HYDRALLAZINE 10X10 A 7.07 0.0707 TAB 120 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD B 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 ORAL 6 DIRECT VASODILATOR
40 11615 APO-HYDRALLAZINE 25MG TAB (APO/COL) HYDRALLAZINE APO-HYDRALLAZINE 100'S A 7.20 0.07 TABLET 120 TAB APO APOTEX INC. COL COLLINS LTD B 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 1161AA HYDRALLAZINE 25MG TAB (LDP) HYDRALLAZINE HYDRALLAZINE 250'S A 14.87 0.0595 TAB 120 BOTT LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC B 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 ORAL 6 DIRECT VASODILATOR
41 1161AC APO-HYDRALLAZINE 25MG TAB (APO) HYDRALLAZINE APO-HYDRALLAZINE 100'S A 6.42 0.0642 TAB 120 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 ORAL 6 DIRECT VASODILATOR
40 11625 APO-HYDRALLAZINE 50MG TAB (APO/COL) HYDRALLAZINE APO-HYDRALLAZINE 100'S A 16.55 0.17 TABLET 60 TAB APO APOTEX INC. COL COLLINS LTD B 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 1162AA APO-HYDRALAZINE 50MG TAB (APO) HYDRALLAZINE APO-HYDRALAZINE 100'S A 13.32 0.1332 TAB 60 BOTT APO APOTEX INC. ATB ANSA TRADING BARBADOS LTD B 2408 HYPOTENSIVE AGENTS 2024-04-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS
40 1162T HYDRALLAZINE 50MG TAB (FSB/ATB) HYDRALLAZINE HYDRALLAZINE 25X10 A 32.62 0.13 TABLET 60 TAB FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 11637 HYDRALLAZINE 20MG/ML INJ (FSB) (B) HYDRALLAZINE HYDRALLAZINE 20MG VIAL B 38.11 38.1109 VIAL 0 VIAL FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 0 DIRECT VASODILATOR
40 1163H HYDRALLAZINE 20MG/ML INJ (MON/PHA) HYDRALLAZINE HYDRALLAZINE 10X1ML B 43.17 4.32 INJECTION 0 VIAL MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
40 1163J LAHYZINE 20MG/ML INJ (LDP/AHI) HYDRALLAZINE HYDRALLAZINE LAHYZINE 20MG VIAL B 5.71 5.71 INJECTION 0 VIAL LDP LABDHI PHARMA AHI ARMSTRONG HEALTHCARE INC 240820 DIRECT VASODILATOR 2022-04-01 2024-03-31 IV 0 CARDIOVASCULAR DRUGS
41 1163K HYDRALLAZINE 20MG/ML INJ (DIL) (B) HYDRALLAZINE HYDRALLAZINE 25X1ML B 938.75 37.5498 VIAL 0 BOX DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 240820 DIRECT VASODILATOR 2024-04-01 2026-03-31 IV 0 DIRECT VASODILATOR