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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
42 3261AB POVIDONE IODINE 1% SOLN (FSB) POVIDONE IODINE POVIDONE IODINE 1 LITRE B 17.37 0.02 ML 500 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-04-01 Add to Contract as Cat B TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-03-05
40 3261B VIDENE ANTISEPTIC 1% SOLN (ECO/COL) POVIDONE POVIDONE IODINE VIDENE ANTISEPTIC 500ML B 13.59 0.03 SOLUTION 0 ML ECO ECOLAB LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3261S POVIDONE IODINE 1% SOLN (RIM/PHA) POVIDONE IODINE POVIDONE IODINE 16OZ B 20.26 0.0422 SOLUTION RIM RIMA PHARMACEUTICAL LTD PHA PHARMACY SALES CARIBBEAN 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2023-03-20 2024-03-31 Add to Contract as Cat B TOPICAL ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2023-02-20
40 3261U POVIDONE IODINE 1% SOLN (RYV/ATB) POVIDONE IODINE POVIDONE IODINE 500ML B 8.70 0.02 SOLUTION 0 ML RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2022-07-12 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3261U POVIDONE IODINE 1% SOLN (RYV/ATB) POVIDONE IODINE POVIDONE IODINE 500ML B 11.00 0.02 SOLUTION 0 ML RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-07-13 2024-03-31 Price Change TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-07-12
41 3261U POVIDONE IODINE 1% SOLN (RYV) (B) POVIDONE IODINE POVIDONE IODINE 500ML B 13.51 0.027 ML 500 BOTT RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2024-06-18 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-06-18
41 3261U POVIDONE IODINE 1% SOLN (RYV) (B) POVIDONE IODINE POVIDONE IODINE 500ML B 10.98 0.022 ML 500 BOTT RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-06-19 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-06-19
41 3261W POVIDONE IODINE 1% SOLN (CAR) POVIDONE IODINE (C) POVIDONE IODINE POVIDONE IODINE 500ML C 21.58 0.0432 ML 500 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS
41 3261Z POVIDONE IODINE 1% SOLN (FSB) (B) POVIDONE IODINE POVIDONE IODINE 1 LITRE B 20.71 0.0207 ML 500 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS
41 3262B POVIDONE IODINE SURGICAL 0.75% SCRUB (RIM) POVIDONE IODINE POVIDONE IODINE SURGICAL 1 GAL B 81.5497 0.0216 ML 500 BOTT RIM RIMA PHARMACEUTICAL LTD PHA PHARMACY SALES CARIBBEAN 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2024-04-01 2026-03-31 TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS
40 3262E VIDENE SURGICAL SCRUB 0.75% (ECO/COL) POVIDO POVIDONE IODINE VIDENE SURGICAL SCRUB 500ML B 15.85 0.03 SCRUB 0 ML ECO ECOLAB LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3262H POVIDONE IODINE 0.75% SCRUB (CHC/ATB) POVIDONE IODINE POVIDONE IODINE 500ML B 7.61 0.02 SCRUB 0 ML CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3262J POVIDONE IODINE 0.75% SCRUB (CHC/ATB) DISPENSER POVIDONE IODINE POVIDONE IODINE 500ML B 8.43 0.02 SCRUB 0 ML CHC CARITAS HEALTHCARE PVT LTD ATB ANSA TRADING BARBADOS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
42 3262K POVIDONE IODINE SCRUB (CHC) POVIDONE IODINE POVIDONE IODINE 500ML B 250.77 0.50 ML 0 CHC CARITAS HEALTHCARE PVT LTD STO BRYDEN STOKES LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-04-01 Add to Contract as Cat B TOPICAL 6 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2026-03-05