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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 17635 PROMETHAZINE 25MG/ML INJ (STP) (B) PROMETHAZINE PROMETHAZINE 100X2ML B 217.47 2.1747 AMP 30 BOX STP STEROP LABORATORIES COL COLLINS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2024-04-01 2026-03-31 INJ 0 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCEL
42 17635 PROMETHAZINE 25MG/ML INJ (STP) PROMETHAZINE PROMETHAZINE 100X2ML B 217.47 2.17 AMPG 30 BOX STP STEROP LABORATORIES COL AVENTA BARBADOS 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2026-04-01 IM 0 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCEL
40 17639 PROMETHAZINE 25MG/ML INJ (KWA/ATB) PROMETHAZINE PROMETHAZINE 5X2ML B 57.08 11.42 INJECTION 0 AMP KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2024-03-31 IM 0 CENTRAL NERVOUS SYSTEM DRUGS
40 1763L PROMETHAZINE 25MG/ML INJ (ROL/AHI) PROMETHAZINE PROMETHAZINE 25X1ML B 204.04 8.16 INJECTION 0 AMP ROL ROXANE LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2022-09-30 IV 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29