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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 A321AH VENLAFAXINE ER 37.5MG TAB (APL/AHI) VENLAFAXI VENLAFAXINE VENLAFAXINE ER 30'S BP 10.90 0.36 TABLET 0 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 A321AJ VENLAFAXINE 37.5MG TAB (ZYD) VENLAFAXINE VENLAFAXINE 100'S BP 11.1451 0.1115 TAB 42 BOTT ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 6 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A321AJ VENLAFAXINE 37.5MG TAB (ZYD) VENLAFAXINE VENLAFAXINE 100'S BP 12.15 0.12 TAB 42 BLIS ZYD ZYDUS AHI ARMSTRONG HEALTHCARE INC 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
40 A321S VENLAFAXINE SR 37.5MG CAP (CIP/AHI) VENLAFAXINE VENLAFAXINE SR 100'S BP 35.20 0.35 CAPSULE 0 CAP CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 A322BT VENLAFAXINE 150MG SR TAB (CIP) (BP) VENLAFAXINE VENLAFAXINE 100'S BP 125.75 1.2575 TABSR 0 BOX CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE
42 A322BT VENLAFAXINE 150MG SR TAB (CIP) VENLAFAXINE VENLAFAXINE 100'S BP 128.03 1.28 TAB 0 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2026-04-01 ORAL 0 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE
41 A322BU VENLAFAXINE 75MG SR TAB (CIP) (BP) VENLAFAXINE VENLAFAXINE 100'S BP 64.42 0.6442 TABSR 0 BOX CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE
42 A322BU VENLAFAXINE 75MG SR TAB (CIP) VENLAFAXINE VENLAFAXINE 100'S BP 71.68 0.72 TAB 0 BLIS CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2026-04-01 ORAL 0 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE
40 A322FZ PRISTIQ 50MG TAB (PFI/STO) DESVENLAFAXINE DESVENLAFAXINE PRISTIQ 28'S C 95.49 3.41 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 A322FZ PRISTIQ 50MG TAB (PFI) DESVENLAFAXINE (C) DESVENLAFAXINE PRISTIQ 28'S C 96.45 3.4445 TAB 0 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2024-04-01 2026-03-31 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
42 A322FZ PRISTIQ 50MG TAB (PFI) DESVENLAFAXI DESVENLAFAXINE PRISTIQ 28'S C 96.45 3.44 TAB 0 BLIS PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2026-04-01 ORAL 0 SELECTIVE SEROTONIN REUPTAKE INHIBITORS
40 A322GA EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-08-23 Delete from contract Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-07-12
40 A322GB EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-08-23 Delete from contract Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-07-12
40 A322JV VENLAFAXINE SR 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE SR 1000'S BP 516.21 0.52 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-09-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A322JY VENLAFAXINE SR 150MG TAB (WAT/AHI) VENLAFAXIN VENLAFAXINE VENLAFAXINE SR 90'S BP 64.32 0.71 TABLET 0 TAB WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2022-09-30 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29
40 A322KE EFFEXOR XR 75MG CAP (PFI/SBI) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KR VENLAFAXINE ER 150MG CAP (APL/AHI) VENLAFAXIN VENLAFAXINE VENLAFAXINE ER 90'S BP 69.43 0.77 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KS VENLAFAXINE ER 75MG CAP (APL/AHI) VENLAFAXINE VENLAFAXINE VENLAFAXINE ER 30'S BP 18.97 0.63 CAPSULE 0 CAP APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KV EFFEXOR XR 150MG CAP (PFI/SBI) VENLAFAXINE VENLAFAXINE EFFEXOR XR 14'S C 67.80 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION SBI MASSY DISTRIBUTION (BDOS) LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Price Change Oral 0 CENTRAL NERVOUS SYSTEM DRUGS 2022-04-01
40 A322KX EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE VENLAFAXINE EFFEXOR XR 28'S C 135.59 4.84 CAPSULE 0 CAP PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 28160416 SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS 2022-07-12 2024-03-31 Package Size Change Oral CENTRAL NERVOUS SYSTEM DRUGS 2022-07-12