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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 0012ER GLENCET 5MG TAB (GLP/ALI) LEVOCETIRIZINE LEVOCETIRIZINE GLENCET 30'S C 6.80 0.23 TABLET 0 TAB GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2022-03-22 Delete from contract Oral 0 ANTIHISTAMINICS 2022-03-22
40 0012FD GLENCET 5MG TAB (GLP/ATB) LEVOCETIRIZINE LEVOCETIRIZINE GLENCET 30'S C 6.80 0.23 TABLET 0 TAB GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Change Local Agent Oral 0 ANTIHISTAMINICS 2022-03-22
40 0114BP ALTACEF 250MG TAB (GLP/ATB) CEFUROXIME CEFUROXIME ALTACEF 10'S BQ 4.08 0.41 TABLET 0 TAB GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Change Local Agent Oral 6 ANTI-INFECTIVE AGENTS 2022-03-22
41 0487B METRONIDAZOLE 0.75% GEL (GLP) (C) METRONIDAZOLE METRONIDAZOLE 30G C 26.5852 26.5852 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 0832 TRICHOMONACIDES 2024-04-01 2026-03-31 TOPICAL 0 TRICHOMONACIDES
41 1011H HEPARIN 5000U/ML INJ (GLN) (B) HEPARIN HEPARIN 25X5ML B 252.29 10.0915 VIAL 0 BOX GLN GLAND AHI ARMSTRONG HEALTHCARE INC 20120416 HEPARINS 2024-04-01 2026-03-31 IV 0 HEPARINS
42 1134BA ROSUVASTATIN 40MG TAB (GLP) ROSUVASTATIN ROSUVASTATIN 90'S A 14.27 0.16 TAB 30 BLIS GLP GLENMARK PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 240608 HMG-CoA REDUCTASE INHIBITORS 2026-04-01 ORAL 6 HMG-CoA REDUCTASE INHIBITORS
42 2641A BUDESMA 200MCG INHR (GLP) BUDESONIDE BUDESONIDE BUDESMA 120 DOSES A 6.01 6.01 INHR 1 CNN GLP GLENMARK PHARMACEUTICALS LTD STO BRYDEN STOKES LTD B 481008 CORTICOSTEROIDS (RESPIRATORY) 2026-04-01 ORAL 6 CORTICOSTEROIDS (RESPIRATORY)
40 4253AV SUPIROCIN 2% OINT (GLP/ATB) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 5.44 5.44 OINT 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 Change Local Agent TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
42 4253AW SUPIROCIN 2% OINT (GLP) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 4.89 4.89 TUBE 2 BOX GLP GLENMARK PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 0 ANTIBIOTICS TOPICAL
42 4253BA SUPIROCIN 2% OINT (GLP) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 4.89 4.89 TUBE 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 0 ANTIBIOTICS TOPICAL
40 4253P SUPIROCIN 2% OINT (GLP/ALI) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 5.44 5.44 OINT 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 4291Q VANCOMYCIN 500MG INJ (GLN/AHI) VANCOMYCIN VANCOMYCIN 500MG VIAL BQ 5.27 5.27 INJECTION 0 VIAL GLN GLAND AHI ARMSTRONG HEALTHCARE INC 08122816 GLYCOPEPTIDES 2022-04-01 2022-09-30 IV 0 ANTI-INFECTIVE AGENTS 2022-03-29
42 5231CH CANDID 1% CREAM (GLP) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 20G A 1.09 1.09 TUBE 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2026-04-01 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5231DU CELAMINA 1% CR (GLP/ALI) CICLOPIROX OLAMINE CICLOPIROX OLAMINE CELAMINA 20G A 6.80 6.80 CREAM 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5231EV CELAMINA 1% CR (GLP/ATB) CICLOPIROX OLAMINE CICLOPIROX OLAMINE CELAMINA 20G A 6.80 6.80 CREAM 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 Change Local Agent TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
42 5231FY CANDID 1% CR (GLP) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 20G A 1.09 1.09 TUBE 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 081404 ALLYAMINES 2026-04-01 TOPICAL 0 ALLYAMINES
40 5232AZ CANDID 1% EAR DR (GLP/ALI) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 15ML A 6.80 6.80 EAR DROP 1 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract OTIC 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232BN CANDID 1% EAR DR (GLP/ATB) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 15ML A 6.80 6.80 EAR DROP 1 BOTT GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 Change Local Agent OTIC 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232BP CANDID MOUTH PAINT 1% SOLN (GLP/ATB) CLOTRIMA CLOTRIMAZOLE CANDID MOUTH PAINT 20ML A 6.80 6.80 SOLUTION 2 BOTT GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 Change Local Agent TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232ZA CANDID MOUTH PAINT 1% SOLN (GLP/ALI) CLOTRIMA CLOTRIMAZOLE CANDID MOUTH PAINT 20ML A 6.80 6.80 SOLUTION 2 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22