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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 A6614 MAXALT 10MG TAB (MSD/STO) RIZATRIPTAN RIZATRIPTAN MAXALT 6'S C 49.91 8.32 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 283228 SELECTIVE SEROTONIN AGONIST 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 A6614 MAXALT 10MG TAB (MSD) RIZATRIPTAN (C) RIZATRIPTAN MAXALT 6'S C 50.4 8.3996 TAB 14 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 283228 SELECTIVE SEROTONIN AGONIST 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN AGONIST
42 A6614 MAXALT 10MG TAB (MSD) RIZATRIPTAN RIZATRIPTAN MAXALT 6'S C 50.40 8.40 TAB 14 BLIS MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 283228 SELECTIVE SEROTONIN AGONIST 2026-04-01 ORAL 6 SELECTIVE SEROTONIN AGONIST
41 A661BA PMS-RIZATRIPTAN 10MG TAB (PMS) RIZATRIPTAN PMS-RIZATRIPTAN 6'S A 21.2 3.5338 TAB 14 BOTT PMS PHARMASCIENCE COL COLLINS LTD 283228 SELECTIVE SEROTONIN AGONIST 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN AGONIST
42 A661BA PMS-RIZATRIPTAN 10MG TAB (PMS) RIZATRIPTAN PMS-RIZATRIPTAN 6'S A 18.89 3.15 TAB 14 BOTT PMS PHARMASCIENCE COL AVENTA BARBADOS 283228 SELECTIVE SEROTONIN AGONIST 2026-04-01 ORAL 6 SELECTIVE SEROTONIN AGONIST