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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 0012EY AERIUS 5MG TAB (MSD/STO) DESLORATADINE DESLORATADINE AERIUS 30'S C 24.95 0.83 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0012EY AERIUS 5MG TAB (MSD) DESLORATADINE (C) DESLORATADINE AERIUS 30'S C 25.2 0.84 TAB 0 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
42 0012EY AERIUS 5MG TAB (MSD) DESLORATADINE DESLORATADINE AERIUS 30'S C 25.20 0.84 TAB 0 BLIS MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 0013BK AERIUS 0.5MG/ML SYR (MSD/STO) DESLORATADINE DESLORATADINE AERIUS 60ML C 11.74 0.20 SYRUP 0 ML MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0013BK AERIUS 0.5MG/ML SYR (MSD) DESLORATADINE (C) DESLORATADINE AERIUS 60ML C 11.88 0.198 ML 60 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0404 FIRST GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 FIRST GENERATION ANTIHISTAMINES
42 0013BK AERIUS 0.5MG/ML SYR (MSD) DESLORATADINE DESLORATADINE AERIUS 60ML C 11.88 0.20 ML 60 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0404 FIRST GENERATION ANTIHISTAMINES 2026-04-01 ORAL 0 FIRST GENERATION ANTIHISTAMINES
42 0013BZ CETIRIZINE 1MG/ML SYR (HEA) CETIRIZINE CETIRIZINE 60ML A 2.83 0.05 ML 60 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-26
42 0013CA LORATADINE 1MG/ML SYR (HEA) LORATADINE LORATADINE 100ML A 3.10 0.03 ML 120 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-26
42 0014V CHLORPHENIRAMINE 10MG/ML INJ (FSB) CHLORPHENIRAMINE CHLORPHENIRAMINE 10X1ML B 3.81 0.38 VIAL 0 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 0404 FIRST GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat B IV/IM 6 FIRST GENERATION ANTIHISTAMINES 2026-03-05
42 0081AK AMPHIZOME 50MG INJ (FSB) AMPHOTERICIN B AMPHOTERICIN B AMPHIZOME 5ML BQ 12.53 12.53 VIAL 21 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 081408 AZOLES 2026-04-01 Add to Contract IV 0 AZOLES 2026-03-05
42 0102AB NYSTATIN 100,000U/ML SUSP (FSB) NYSTATIN NYSTATIN 60ML A 5.14 0.09 ML 180 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-03-05
42 0102AC NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-02-26
42 0113AK CEFAZOLIN 1G INJ (BAX) CEFAZOLIN CEFAZOLIN 10ML VIAL BQ 2.75 2.75 VIAL 0 VIAL BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 08120604 FIRST GEN CEPHALOSPORINS 2026-04-01 IV 0 FIRST GEN CEPHALOSPORINS
42 0124AF CHLORAMPHENICOL 0.5% EYE DR (FSB) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.36 1.36 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 520404 EENT ANTIBACTERIALS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 0 EENT ANTIBACTERIALS 2026-03-05
40 01261 CHLORAMPHENICOL MINIMS 0.5% EYE DR (CAM/STO) CHLORAMPHENICOL CHLORAMPHENICOL MINIMS 20X0.5ML BQ 94.73 4.74 EYE DROP 0 AMP CAM MORNINGSIDE PHARMACEUTICALS STO BRYDEN STOKES LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 0131U ZITHROMAX 40MG/ML SUSP (PFI/STO) AZITHROMYCIN AZITHROMYCIN ZITHROMAX 15ML C 29.66 1.98 SUSPENSION 0 ML PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0131U ZITHROMAX 40MG/ML SUSP (PFI) AZITHRO (C) AZITHROMYCIN ZITHROMAX 15ML C 29.96 1.9971 ML 30 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2024-04-01 2026-03-31 ORAL 0 OTHER MACROLIDES
42 0131U ZITHROMAX 40MG/ML SUSP (PFI) AZITHR AZITHROMYCIN ZITHROMAX 15ML C 29.96 2.00 ML 30 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 08121292 OTHER MACROLIDES 2026-04-01 ORAL 0 OTHER MACROLIDES
40 0141AH ZITHROMAX 500MG TAB (PFI/STO) AZITHROMYCIN AZITHROMYCIN ZITHROMAX 3'S C 53.01 17.67 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0141AH ZITHROMAX 500MG TAB (PFI) AZITHROMY (C) AZITHROMYCIN ZITHROMAX 3'S C 53.52 17.8413 TAB 7 BOX PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2024-04-01 2026-03-31 ORAL 0 OTHER MACROLIDES