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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 50831 NEBIDO 250MG/ML INJ (BSP/COL) TESTOSTERONE TESTOSTERONE NEBIDO 4ML VIAL BQ 108.73 108.73 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 6808 ANDROGENS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 50833 NEBIDO 250MG/ML INJ (BSP/AHI) TESTOSTERONE TESTOSTERONE NEBIDO 4ML VIAL BQ 108.73 108.73 INJECTION 0 VIAL BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6808 ANDROGENS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
42 50837 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER TESTOSTERONE PRIMOTESTON 250MG AMP BQ 33.14 33.14 AMPG 4 AMP BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 6808 ANDROGENS 2026-04-01 IV 0 ANDROGENS
42 50838 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER TESTOSTERONE PRIMOTESTON 250MG AMP BQ 36.43 36.43 AMPG 4 AMP BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6808 ANDROGENS 2026-04-01 IV 0 ANDROGENS
40 5083C TESTOSTERONE 250MG/ML INJ (RTM/PHA) TESTOSTERONE TESTOSTERONE 10X1ML BQ 140.81 14.08 INJECTION 0 AMP RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 6808 ANDROGENS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 5083C TESTOSTERONE 250MG/ML INJ (RTM) (BQ) TESTOSTERONE TESTOSTERONE 10X1ML BQ 157.34 15.7337 AMP 4 BOX RTM PANPHARMA GMBH PHA PHARMACY SALES CARIBBEAN 6808 ANDROGENS 2024-04-01 2026-03-31 IV 6 ANDROGENS
41 5083D SOSTENON 250MG/ML INJ (ASG) TESTOSTERONE (BQ) TESTOSTERONE SOSTENON 250MG PFS BQ 34.17 34.1693 PFS 4 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 6808 ANDROGENS 2024-04-01 2026-03-31 IM 6 ANDROGENS