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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
41 62115 DORMICUM 5MG/ML INJ (ROC) MIDAZOLAM (B) MIDAZOLAM DORMICUM 5X3ML B 19.03 3.8057 AMP 0 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 282408 BENZODIAZEPINES (SEDATIVES) 2024-04-01 2026-03-31 INJ 0 BENZODIAZEPINES (SEDATIVES)
42 6211AA HYNOFAST 5MG/ML INJ (INC) MIDAZOLAM MIDAZOLAM HYNOFAST 3ML B 4.89 4.89 VIAL 0 VIAL INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 282408 BENZODIAZEPINES (SEDATIVES) 2026-04-01 IM 0 BENZODIAZEPINES (SEDATIVES)
40 6211D MIDAZOLAM 5MG/ML INJ (RTM/PHA) MIDAZOLAM MIDAZOLAM 10X3ML B $36.50 2.62 INJECTION 0 AMP RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 PRICE CHANGE IV 0 CENTRAL NERVOUS SYSTEM DRUGS 0000-00-00
41 6211D MIDAZOLAM 5MG/ML INJ (RTM) (B) MIDAZOLAM MIDAZOLAM 10X3ML B 24.85 2.485 AMP 0 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 282408 BENZODIAZEPINES (SEDATIVES) 2024-04-01 2025-01-28 IV 0 BENZODIAZEPINES (SEDATIVES)
41 6211D MIDAZOLAM 5MG/ML INJ (RTM) (B) MIDAZOLAM MIDAZOLAM 10X3ML B 36.5 3.65 AMP 0 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 282408 BENZODIAZEPINES (SEDATIVES) 2024-05-25 2026-03-31 IV 0 BENZODIAZEPINES (SEDATIVES) 2024-04-01
41 62121 DORMICUM 5MG/ML INJ (ROC) MIDAZOLAM (C) MIDAZOLAM DORMICUM 5X10ML C 51.65 10.3296 VIAL 0 BOX ROC ROCHE SERVICIOS S.A. AHI ARMSTRONG HEALTHCARE INC 282408 BENZODIAZEPINES (SEDATIVES) 2024-04-01 2026-03-31 IV 0 BENZODIAZEPINES (SEDATIVES)
41 6212N MIDAZOLAM 5MG/ML INJ (KWA) (B) MIDAZOLAM MIDAZOLAM 10ML VIAL B 4.08 4.0775 VIAL 0 VIAL KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2024-04-01 2026-03-31 IV 0 BENZODIAZEPINES (SEDATIVES)
40 6212P MIDAZOLAM 5MG/ML INJ (BRA/COL) MIDAZOLAM MIDAZOLAM 20X10ML B 67.22 3.36 INJECTION 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
41 6212P MIDAZOLAM 5MG/ML INJ (BRA) (B) MIDAZOLAM MIDAZOLAM 20X10ML B 93.13 4.6565 VIAL 0 BOX BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL COLLINS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2024-04-01 2026-03-31 IV 0 BENZODIAZEPINES (SEDATIVES)
42 6212P MIDAZOLAM 5MG/ML INJ (BRA) MIDAZOLAM MIDAZOLAM 20X10ML B 215.29 10.76 VIAL 0 VIAL BRA B. BRAUN MELSUNGEN AG CARL-BRAUN-STRABE COL AVENTA BARBADOS 282408 BENZODIAZEPINES (SEDATIVES) 2026-04-01 IV 0 BENZODIAZEPINES (SEDATIVES)