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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 0112BB CEFADROXIL MK 50MG/ML SUSP (BON/COL) CEFADROX CEFADROXIL CEFADROXIL MK 60ML A 8.54 0.14 SUSPENSION 120 ML BON CORPORACION BONIMA COL COLLINS LTD 08120604 FIRST GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AE AZITHROMYCIN MK 40MG/ML SUSP (BON/COL) AZITHROMYCIN AZITHROMYCIN MK 15ML A 5.30 0.35 SUSPENSION 30 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AF CLARITHROMYCIN MK 50MG/ML SUSP (BON/COL) CLARITHROMYCIN CLARITHROMYCIN MK 60ML A 14.27 0.24 SUSPENSION 60 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AH CLARITHROMYCIN MK 25MG/ML SUSP (BON/COL) CLARITHROMYCIN CLARITHROMYCIN MK 60ML A 9.38 0.16 SUSPENSION 100 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AL ERYTHROMYCIN 50MG/ML SUSP (BON/COL) ERYTHROMY ERYTHROMYCIN ESTOLATE ERYTHROMYCIN 60ML A 7.75 0.13 SUSPENSION 300 ML BON CORPORACION BONIMA COL COLLINS LTD 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE/STO) TIOTRO TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 111.29 111.29 INHALER 0 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE) TIOTR (BQ) TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 121.59 121.5906 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2024-04-01 2026-03-31 ORAL INHALATION 6 ANTICHOLINERGIC AGENTS (RESPIRATORY)
42 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE) TIOTR TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 121.59 121.59 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2026-04-01 ORAL INHALATION 0 ANTICHOLINERGIC AGENTS (RESPIRATORY)
40 09118 SPIOLTO RESPIMAT 2.5/2.5MCG INHR (BOE/STO) TI OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 111.29 111.29 INHALER 1 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP (BQ) OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 121.59 121.5906 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2024-04-01 2026-03-31 ORAL INHALATION 6 ANTICHOLINERGIC AGENTS (RESPIRATORY)
42 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 121.59 121.59 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2026-04-01 ORAL INHALATION 0 ANTICHOLINERGIC AGENTS (RESPIRATORY)
40 4141LB INDOMETHACIN MK 25MG CAP (BON/COL) INDOMETHAC INDOMETHACIN INDOMETHACIN MK 100'S BQ 8.43 0.08 CAPSULE 0 CAP BON CORPORACION BONIMA COL COLLINS LTD 28080492 OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 55314 TWYNSTA 5MG | 80MG TAB (BOE/STO) AMLODIPINE | TELMISARTAN AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.90 TABLET 30 TAB BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 55314 TWYNSTA 5MG|80MG TAB (BOE) AMLODIPINE|TELMISARTAN AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.897 TAB 30 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
42 55314 TWYNSTA 5MG|80MG TAB (BOE) AMLODIP (C) AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.90 TAB 30 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 55324 TWYNSTA 10MG | 80MG TAB (BOE/STO) AMLODIPINE | TELMISARTAN AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.90 TABLET 30 TAB BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 55324 TWYNSTA 10MG|80MG TAB (BOE) AMLODIPINE|TELMISARTAN AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.897 TAB 30 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
42 55324 TWYNSTA 10MG|80MG TAB (BOE) AMLODI (C) AMLODIPINE|TELMISARTAN TWYNSTA 28'S A 25.12 0.90 TAB 30 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD B 240892 HYPOTENSIVE AGENTS, MISCELLANEOUS 2026-04-01 ORAL 6 HYPOTENSIVE AGENTS, MISCELLANEOUS
40 5762G KETOTIFEN MK 0.2MG/ML SYR (BON/COL) KETOTIFEN KETOTIFEN KETOTIFEN MK 100ML A 4.10 0.04 SYRUP 100 ML BON CORPORACION BONIMA COL COLLINS LTD B 481032 MAST CELL STABILISERS 2022-04-01 2024-03-31 Oral 6 RESPIRATORY TRACT AGENTS
42 5962A TRAJENTAMET 2.5MG|850MG TAB (BOE) LINAGLIPTIN|METFORMIN LINAGLIPTIN|METFORMIN TRAJENTAMET 60'S C 114.66 1.91 TAB 0 BLIS BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 682005 DIPEPTIDYL PEPTIDASE INHIBITORS 2026-04-01 ORAL 0 DIPEPTIDYL PEPTIDASE INHIBITORS