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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 59311 PROCORALAN 5MG TAB (SER/STO) IVABRADINE IVABRADINE PROCORALAN 28'S C 60.87 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-06 2024-03-31 Package Size Change Oral 0 CARDIOVASCULAR DRUGS 2022-04-06
40 59314 PROCORALAN 5MG TAB (SER/COL) IVABRADINE IVABRADINE PROCORALAN 28'S C 60.87 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-13 2024-03-31 Add to Contract as Cat C Oral 0 CARDIOVASCULAR DRUGS 2022-04-13
40 59319 PROCOROLAN 5MG TAB (SER/COL) IVABRADINE IVABRADINE PROCOROLAN 56'S C 121.73 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 59319 PROCOROLAN 5MG TAB (SER) IVABRADINE (C) IVABRADINE PROCOROLAN 56'S C 109.09 1.948 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS
40 5931A PROCORLAN 5MG TAB (SER/STO) IVABRADINE IVABRADINE PROCORLAN 56'S C 121.73 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 5931A PROCORLAN 5MG TAB (SER) IVABRADINE (C) IVABRADINE PROCORLAN 56'S C 109.09 1.948 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS
40 5931B IVABRADINE 5MG TAB (INP/AHI) IVABRADINE IVABRADINE 56'S BQ 55.59 0.99 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 5931C BRADIREM 5MG TAB (REM) IVABRADINE (BQ) IVABRADINE BRADIREM 56'S BQ 18.43 0.3291 TAB 0 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS
40 59321 PROCORALAN 7.5MG TAB (SER/STO) IVABRADINE IVABRADINE PROCORALAN 28'S C 60.87 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Package Size Change Oral 0 CARDIOVASCULAR DRUGS 2022-04-06
40 59323 PROCORALAN 7.5MG TAB (SER/COL) IVABRADINE IVABRADINE PROCORALAN 28'S C 60.87 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-13 2024-03-31 Add to Contract as Cat C Oral 0 CARDIOVASCULAR DRUGS 2022-04-13
40 59326 PROCOROLAN 7.5MG TAB (SER/COL) IVABRADINE IVABRADINE PROCOROLAN 56'S C 121.73 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 59326 PROCOROLAN 7.5MG TAB (SER) IVABRADI (C) IVABRADINE PROCOROLAN 56'S C 109.09 1.948 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS
40 59327 PROCORLAN 7.5MG TAB (SER/STO) IVABRADINE IVABRADINE PROCORLAN 56'S C 121.73 2.17 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 59327 PROCORLAN 7.5MG TAB (SER) IVABRADIN (C) IVABRADINE PROCORLAN 56'S C 109.09 1.948 TAB 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS
40 59328 IVABRADINE 7.5MG TAB (INP/AHI) IVABRADINE IVABRADINE 56'S BQ 61.76 1.10 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 240492 CARDIAC DRUGS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 59329 BRADIREM 7.5MG TAB (REM) IVABRADINE (BQ) IVABRADINE BRADIREM 56'S BQ 26.53 0.4738 TAB 0 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 240492 CARDIAC DRUGS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 0 CARDIAC DRUGS MISCELLANEOUS