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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 15117 PHENYTOIN CHEW 50MG TAB (KWA/ATB) PHENYTOIN PHENYTOIN PHENYTOIN CHEW 10X10 A 48.93 0.49 TABLET 180 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 281212 HYDANTOINS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 15123 DILANTIN 100MG CAP (PFI/SBI) PHENYTOIN PHENYTOIN DILANTIN 100'S A 35.99 0.36 CAPSULE 180 CAP PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 281212 HYDANTOINS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 15123 DILANTIN 100MG CAP (PFI) PHENYTOIN PHENYTOIN DILANTIN 100'S A 35.99 0.3599 CAP 180 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 281212 HYDANTOINS 2024-04-01 2026-03-31 ORAL 6 HYDANTOINS
42 1512AJ DILANTIN 100MG CAP (PFI) PHENYTOIN PHENYTOIN DILANTIN 100'S A 35.99 0.36 CAP 180 BOTT PFI PFIZER CORPORATION COL AVENTA BARBADOS B 281212 HYDANTOINS 2026-04-01 ORAL 6 HYDANTOINS
42 1512AP PHENYTOIN 100MG CHEW TAB (KWA) PHENYTOIN PHENYTOIN 100'S A 17.83 0.18 TAB 180 KWA KWALITY PHARMACEUTICALS STO BRYDEN STOKES LTD B 2812 ANTICONVULSANTS 2026-04-01 Add to Contract as Cat A ORAL 6 ANTICONVULSANTS 2026-03-02
41 1512G PHENYTOIN 100MG CHEW TAB (KWA) PHENYTOIN PHENYTOIN 100'S A 18.02 0.1802 TABCH 180 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD B 281212 HYDANTOINS 2024-04-01 2026-03-31 ORAL 6 HYDANTOINS
40 1512T DILANTIN 100MG CAP (PFI/STO) PHENYTOIN PHENYTOIN DILANTIN 100'S A 35.99 0.36 CAPSULE 180 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 281212 HYDANTOINS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 1512T DILANTIN 100MG CAP (PFI) PHENYTOIN PHENYTOIN DILANTIN 100'S A 35.99 0.3599 CAP 180 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 281212 HYDANTOINS 2024-04-01 2026-03-31 ORAL 6 HYDANTOINS
40 15132 DILANTIN 25MG/ML SUSP (PFI/SBI) PHENYTOIN PHENYTOIN DILANTIN 240ML A 61.35 0.26 SUSPENSION 600 ML PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 281212 HYDANTOINS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 15132 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN PHENYTOIN DILANTIN 237ML A 61.35 0.2589 ML 600 BOTT PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD B 281212 HYDANTOINS 2024-04-01 2026-03-31 ORAL 6 HYDANTOINS
40 15134 DILANTIN 25MG/ML SUSP (PFI/STO) PHENYTOIN PHENYTOIN DILANTIN 240ML A 61.35 0.26 SUSPENSION 600 ML PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 281212 HYDANTOINS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 15134 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN PHENYTOIN DILANTIN 237ML A 61.35 0.2589 ML 600 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 281212 HYDANTOINS 2024-04-01 2026-03-31 ORAL 6 HYDANTOINS
42 1513B DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN PHENYTOIN DILANTIN 237ML A 61.35 0.26 ML 600 BOTT PFI PFIZER CORPORATION COL AVENTA BARBADOS B 281212 HYDANTOINS 2026-04-01 ORAL 6 HYDANTOINS
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) PHENYTOIN PHENYTOIN 5X5ML B 7.80 1.56 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 281212 HYDANTOINS 2022-04-01 2022-07-18 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) PHENYTOIN PHENYTOIN 5X5ML B 9.62 1.92 INJECTION 0 AMP MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 281212 HYDANTOINS 2022-07-19 2024-03-31 Price Change IV 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-07-18
42 1514M PHENYTOIN 50MG/ML INJ (MON) PHENYTOIN PHENYTOIN 5X5ML B 8.02 1.60 AMPG 2 BOX MON MONTAGE PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 281212 HYDANTOINS 2026-04-01 IV 0 HYDANTOINS
41 1514N EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) PHENYTOIN EPAMIN 10X5ML C 365.91 36.591 VIAL 2 BOX PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 281212 HYDANTOINS 2024-04-01 2026-03-31 IV 0 HYDANTOINS
40 1514P EPAMIN 50MG/ML INJ (PFI/STO) PHENYTOIN PHENYTOIN EPAMIN 10X5ML C 362.62 36.26 INJECTION 0 AMP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 281212 HYDANTOINS 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
41 1514P EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) PHENYTOIN EPAMIN 10X5ML C 365.91 36.5914 AMP 2 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 281212 HYDANTOINS 2024-04-01 2026-03-31 IV 0 HYDANTOINS
41 1514R PHENYTOIN 50MG/ML INJ (STP) (B) PHENYTOIN PHENYTOIN 100X5ML B 326.2 3.262 AMP 2 BOX STP STEROP LABORATORIES COL COLLINS LTD 281212 HYDANTOINS 2024-04-01 2026-03-31 IV 0 HYDANTOINS