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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 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRENATAL MULTIVITAMINS PRENATAL NATELE 28'S C 13.97 0.50 CAPSULE 0 CAP BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2022-09-30 Oral 0 VITAMINS 2022-03-29
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS + M (C) MULTIVITAMINS PRENATAL NATELE 28'S C 14.9 0.5321 CAPSULE BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2022-10-01 2023-02-20 Price Change Oral 0 MULTIVITAMIN PREPARATIONS 2023-02-02
40 35311 NATELE CAP (BSP/AHI) MULTIVITAMINS PRE (C) MULTIVITAMINS PRENATAL NATELE 28'S C 15.33 0.5475 CAPSULE BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2023-02-21 2024-03-31 Add to Contract as Cat C Oral MULTIVITAMIN PREPARATIONS 2023-02-21
41 35311 NATELE CAP (BSP) MULTIVITAMINS PRENATAL (C) MULTIVITAMINS PRENATAL NATELE 28'S C 12.59 0.4495 CAP 30 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 6 MULTIVITAMIN PREPARATIONS
40 35313 VITAPLEX P CAP (CAR/COL) MULTIVITAMINS PRENATAL MULTIVITAMINS PRENATAL VITAPLEX P 400'S B 114.17 0.29 CAPSULE 0 CAP CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Oral 0 VITAMINS
41 35313 VITAPLEX P CAP (CAR) MULTIVITAMINS PRENATAL (B) MULTIVITAMINS PRENATAL VITAPLEX P 400'S B 121.65 0.3041 CAP 30 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 6 MULTIVITAMIN PREPARATIONS
42 35313 VITAPLEX P CAP (CAR) MULTIVITAMINS PRENATAL MULTIVITAMINS PRENATAL VITAPLEX P 400'S B 121.65 0.30 CAP 30 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8828 MULTIVITAMIN PREPARATIONS 2026-04-01 ORAL 6 MULTIVITAMIN PREPARATIONS
40 35314 NATELE TAB (BSP/COL) MULTIVITAMINS PRENATAL MULTIVITAMINS PRENATAL NATELE 28'S C 14.90 0.53 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Oral 0 VITAMINS
41 35314 NATELE TAB (BSP) MULTIVITAMINS PRENATAL (C) MULTIVITAMINS PRENATAL NATELE 28'S C 12.59 0.4495 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 0 MULTIVITAMIN PREPARATIONS
40 3532B VITAPLEX M SYR (CAR/COL) MULTIVITAMINS MULTIVITAMINS VITAPLEX M 250ML B 13.54 0.05 SYRUP 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Oral 0 VITAMINS
42 3532B VITAPLEX M SYR (CAR) MULTIVITAMINSMULTIVITAMINS + MINERALS MULTIVITAMINSMULTIVITAMINS + MINERALS VITAPLEX M 250ML B 14.41 0.06 ML 250 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8828 MULTIVITAMIN PREPARATIONS 2026-04-01 ORAL 6 MULTIVITAMIN PREPARATIONS
41 3541AB VITALUX PLUS TAB (ALC) MULTIVITAMINS (C) MULTIVITAMINS VITALUX PLUS 30'S C 28.62 0.9541 TAB 0 BOTT ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 0 MULTIVITAMIN PREPARATIONS
42 3541AC VITAMINS MULTI | TAB (KWA) MINERAL|MULTIVITAMIN MULTIVITAMIN|MINERALS MULTIVITAMIN|MINERALS 100'S B 15.60 0.16 TAB 0 KWA KWALITY PHARMACEUTICALS STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2026-04-01 Add to Contract as Cat B ORAL 0 MULTIVITAMIN PREPARATIONS 2026-03-02
40 3544D IN FUVITE PAED INJ (BAX/STO) MULTIVITAMINS MULTIVITAMINS IN FUVITE PAED 5 PAIRS B 180.22 36.04 INJECTION 0 INJ BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Price Change IV 0 VITAMINS 2022-05-11
41 3544D IN FUVITE PAED INJ (BAX) MULTIVITAMINS MULTIVITAMINS IN FUVITE PAED 5 PAIRS B 204.39 40.8782 AMP 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 IV 0 MULTIVITAMIN PREPARATIONS
40 35453 INFUVITE ADULT INJ (BAX/STO) MULTIVITAMINS MULTIVITAMINS INFUVITE ADULT 5 PAIRS B 201.16 40.23 INJECTION 0 PAIR BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Price Change IV 0 VITAMINS 2022-05-11
41 35453 INFUVITE ADULT INJ (BAX) MULTIVITAMINS (B) MULTIVITAMINS INFUVITE ADULT 5 PAIRS B 201.16 40.2312 PAIR 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 IV 0 MULTIVITAMIN PREPARATIONS
42 35453 INFUVITE ADULT INJ (BAX) MULTIVITAMINS MULTIVITAMINS INFUVITE ADULT 5 PAIRS B 230.92 46.18 PAIR 0 BOX BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 8828 MULTIVITAMIN PREPARATIONS 2026-04-01 IV 0 MULTIVITAMIN PREPARATIONS
40 35462 PEDIA POLY-VITE DROPS (BYP/PHA) MULTIVITAMINS PAEDIATRIC MULTIVITAMINS PAEDIATRIC PEDIA POLY-VITE 50ML A 10.79 10.79 DROPS 1 BOTT BYP BAYSHORE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 8828 MULTIVITAMIN PREPARATIONS 2022-04-01 2024-03-31 Oral 6 VITAMINS
41 35462 PEDIA POLY-VITE DROPS (BYP) MULTIVITAMINS PAEDIATRIC MULTIVITAMINS PAEDIATRIC PEDIA POLY-VITE 50ML A 11.66 11.6616 BOTT 1 BOTT BYP BAYSHORE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 8828 MULTIVITAMIN PREPARATIONS 2024-04-01 2026-03-31 ORAL 6 MULTIVITAMIN PREPARATIONS