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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 06417 ACCORD MITOMYCIN 5MG INJ (INP/AAL) MITOMYCIN MITOMYCIN ACCORD MITOMYCIN 5MG VIAL BQ 203.06 203.06 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 11045 ACCORD PROPRANOLOL 80MG TAB (INP/AAL) PROPRANOLOL ACCORD PROPRANOLOL 56'S A 13.40 0.24 TABLET 150 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1601AL ACCORD DIAZEPAM 2MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 2.34 0.08 TABLET 120 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1603AK ACCORD DIAZEPAM 10MG TAB (INP/AAL) DIAZEPAM DIAZEPAM ACCORD DIAZEPAM 30'S A 3.67 0.12 TABLET 60 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1611U DOCETERE 20MG INJ (DRL/AAL) DOCETAXEL DOCETAXEL DOCETERE 1 DS SYRNG C 39.96 39.96 INJECTION 0 PFS DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 19536 IBANDRONIC ACID 1MG/ML INJ (INP/AAL) IBANDRONIC ACID IBANDRONIC ACID 6ML VIAL C 9.51 9.51 INJECTION 0 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 9224 BONE RESORPTION INHIBITORS 2022-04-01 2024-03-31 IV 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 3592D LAMEZ 50MG TAB (INP/AAL) LAMOTRIGINE LAMOTRIGINE LAMEZ 56'S B 58.28 1.04 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 3631AX ACCORD METOCLOPRAMIDE 10MG TAB (INP/AAL) METO METOCLOPRAMIDE ACCORD METOCLOPRAMIDE 30'S A 1.96 0.07 TABLET 90 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
40 3701BE SELECT FLEX PLUS GLUC (JOH/AAL) DIAGNOSTIC B DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
41 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 39.23 39.2254 PACK 1 BOX JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2024-04-01 2026-03-31 6 DIABETES MELLITUS
42 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO DIAGNOSTIC BLOOD GLUCOSE SELECT FLEX PLUS 50'S A 40.39 40.39 PACK 1 BOX JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2026-04-01 2028-03-31 6 DIABETES MELLITUS
40 3701V LIFESCAN ONE TOUCH ULTRA GLUC (JOH/AAL) DIAG DIAGNOSTIC BLOOD GLUCOSE LIFESCAN ONE TOUCH ULTRA 50'S A 39.42 39.42 GLUCOSE STRI 1 PACK JOH JOHNSON & JOHNSON (T'DAD) LTD. AAL A. A. LAQUIS LTD B 3626 DIABETES MELLITUS 2022-04-01 2024-03-31 6 DIAGNOSTIC AGENTS
40 4181BA REDITUX 10MG/ML INJ (DRL/AAL) RITUXIMAB RITUXIMAB REDITUX 50ML C 383.56 383.56 INJECTION 0 VIAL DRL DR. REDDY'S LABORATORIES LTD AAL A. A. LAQUIS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 4841F ZOPICON 7.5MG TAB (INP/AAL) ZOPICLONE ZOPICLONE ZOPICON 100'S A 19.03 0.19 TABLET 30 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 282492 ANXIOLYTICS, SEDATIVES AND HYPNOTICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
42 4941A ALBUMIN 20% INJ (INP) ALBUMIN ALBUMIN 50ML VIAL BQ 277.27 277.27 VIAL 40 VIAL INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 8004 SERUMS 2026-04-01 IV 0 SERUMS
40 65715 SKIZORIL 25MG TAB (INP/AAL) CLOZAPINE CLOZAPINE SKIZORIL 500'S BP 92.45 0.18 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 71318 ACCORD REPAGLINIDE 0.5MG TAB (INP/AAL) REPAGL REPAGLINIDE ACCORD REPAGLINIDE 30'S C 58.36 1.95 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 682016 MEGLITINIDES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 71328 ACCORD REPAGLINIDE 1MG TAB (INP/AAL) REPAGLIN REPAGLINIDE ACCORD REPAGLINIDE 30'S C 87.56 2.92 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 682016 MEGLITINIDES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 7284D TOPAZ 50MG TAB (INP/AAL) TOPIRAMATE TOPIRAMATE TOPAZ 60'S BP 9.51 0.16 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 281292 ANTICONVULSANTS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 7581M ACCORD PIOGLITAZONE 15MG TAB (INP/AAL) PIOGLI PIOGLITAZONE ACCORD PIOGLITAZONE 28'S C 25.53 0.91 TABLET 0 TAB INP INTAS PHARMACEUTICALS LTD AAL A. A. LAQUIS LTD 682028 THIAZOLIDINEDIONES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES