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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 4141LB INDOMETHACIN MK 25MG CAP (BON/COL) INDOMETHAC INDOMETHACIN INDOMETHACIN MK 100'S BQ 8.43 0.08 CAPSULE 0 CAP BON CORPORACION BONIMA COL COLLINS LTD 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 4141RN INDOMETHACIN 25MG CAP (GPC) (BQ) INDOMETHACIN INDOMETHACIN 1000'S BQ 84.1 0.0841 CAP 0 BOTT GPC NEW GUYANA PHARMACEUTICAL CORP. LTD ATB ANSA TRADING BARBADOS LTD 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 ORAL 0 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
42 4141TE INDICID 25MG TAB (JLP) INDOMETHACIN INDOMETHACIN INDICID 100'S C 27.18 0.27 TAB 0 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2026-04-01 ORAL 0 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS