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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 3681G NALOXONE 0.4MG/ML INJ (RTM/PHA) NALOXONE NALOXONE 10X1ML BQ 49.25 4.925 INJECTION RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2022-04-01 2024-03-31 Add to Contract as Cat B IV OPIATE ANTAGONISTS 2023-02-22
41 3681G NALOXONE 0.4MG/ML INJ (RTM) (B) NALOXONE NALOXONE 10X1ML B 57.3 5.7302 AMP 0 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2024-04-01 2026-03-31 IV 0 OPIATE ANTAGONISTS
42 3681G NALOXONE 0.4MG/ML INJ (RTM) NALOXONE NALOXONE 10X1ML B 40.77 4.08 AMPG 0 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2026-04-01 IV 0 OPIATE ANTAGONISTS
41 3681Q N-XONE 0.4MG/ML INJ (VEV) NALOXONE (B) NALOXONE N-XONE 10X1ML B 47.3 4.7299 AMP 0 BOX VEV VERVE HUMANCARE LABORATORIES AHI ARMSTRONG HEALTHCARE INC 2810 OPIATE ANTAGONISTS 2024-04-01 2026-03-31 IV 0 OPIATE ANTAGONISTS
40 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) NALOXONE NALOXONE 5X1ML BQ 13.54 2.71 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 3681T NALOXONE 0.4MG/ML INJ (MON/PHA) NALOXONE NALOXONE 5X1ML BQ 13.54 2.708 INJECTION MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2023-03-20 2024-03-31 Delete from contract IV OPIATE ANTAGONISTS 2023-02-14
42 3681T NALOXONE 0.4MG/ML INJ (MON) NALOXONE NALOXONE 5X1ML B 16.01 3.20 AMPG 0 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2026-04-01 IV 0 OPIATE ANTAGONISTS
40 3681V NALOXONE 0.4MG/ML AMP (RTM/PHA) NALOXONE NALOXONE 10'S 57.86 5.786 AMPOULE GLAS VIAL RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 2810 OPIATE ANTAGONISTS 2023-03-20 2024-03-31 Price Change IV/IM OPIATE ANTAGONISTS 2023-02-14
41 3681W NALOXONE 0.4MG/ML INJ (OMG) (B) NALOXONE NALOXONE 10X1ML B 47.35 4.7353 VIAL 0 BOX OMG OMEGA COL COLLINS LTD 2810 OPIATE ANTAGONISTS 2024-04-01 2026-03-31 IV/IM/SC 0 OPIATE ANTAGONISTS
42 3681W NALOXONE 0.4MG/ML INJ (OMG) NALOXONE NALOXONE 10X1ML B 52.19 5.22 VIAL 0 VIAL OMG OMEGA COL AVENTA BARBADOS 2810 OPIATE ANTAGONISTS 2026-04-01 IV/IM/SC 0 OPIATE ANTAGONISTS