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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 29426 HYDROXYPROGESTERONE 250MG/ML INJ (MON/PHA) HYDROXYPROGESTERONE HYDROXYPROGESTERONE 1ML AMP BQ 3.62 3.62 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6832 PROGESTINS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 29428 HYDROXYPROGESTERONE 250MG/ML INJ (MON) HYDROXYPROGESTERONE HYDROXYPROGESTERONE 5X1ML BQ 12.88 2.577 AMP 0 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6832 PROGESTINS 2024-04-01 2026-03-31 IV 0 PROGESTINS
42 29428 HYDROXYPROGESTERONE 250MG/ML INJ (MON) HYDROXYPROGESTERONE HYDROXYPROGESTERONE 5X1ML BQ 13.18 2.64 AMPG 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 6832 PROGESTINS 2026-04-01 IV 0 PROGESTINS
42 29429 LEGESTRO 250MG/ML INJ (JLP) HYDROXYPROGESTERONE HYDROXYPROGESTERONE LEGESTRO 10X1ML BQ 23.11 23.11 AMPG 0 AMP JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 6832 PROGESTINS 2026-04-01 IM 0 PROGESTINS