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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 1131FK ATORVASTATIN 10MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 1.44 0.05 TABLET 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1132GU ATORVASTATIN 20MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 4.65 0.16 TABLET 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2022-10-19 Delete from contract Oral 6 CARDIOVASCULAR DRUGS 2022-09-07
40 1132GU ATORVASTATIN 20MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 1.74 0.058 TABLET IMMED 30 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2023-03-20 2024-03-31 Add to Contract as Cat A Oral 6 HMG-CoA REDUCTASE INHIBITORS 2023-01-12
40 1133FP ATORVASTATIN 40MG TAB (UME/AHI) ATORVASTATIN ATORVASTATIN 3X10 A 2.53 0.08 TABLET 60 TAB UME UMEDICA AHI ARMSTRONG HEALTHCARE INC 240608 HMG-CoA REDUCTASE INHIBITORS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 11816 CONCOR 2.5MG TAB (MEK/COL) BISOPROLOL BISOPROLOL CONCOR 30'S C 28.81 0.96 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 11816 CONCOR 2.5MG TAB (MEK) BISOPROLOL (C) BISOPROLOL CONCOR 30'S C 28.81 0.9605 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 11816 CONCOR 2.5MG TAB (MEK) BISOPROLOL BISOPROLOL CONCOR 30'S C 30.28 1.01 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 11829 CONCOR 5MG TAB (MEK/COL) BISOPROLOL BISOPROLOL CONCOR 30'S C 28.81 0.96 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 11829 CONCOR 5MG TAB (MEK) BISOPROLOL (C) BISOPROLOL CONCOR 30'S C 28.81 0.9605 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 11829 CONCOR 5MG TAB (MEK) BISOPROLOL BISOPROLOL CONCOR 30'S C 30.28 1.01 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 11842 CONCOR 10MG TAB (MEK/COL) BISOPROLOL BISOPROLOL CONCOR 30'S C 28.81 0.96 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 11842 CONCOR 10MG TAB (MEK) BISOPROLOL (C) BISOPROLOL CONCOR 30'S C 28.81 0.9605 TAB 30 BOX MEK MERCK SERONO COL COLLINS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
42 11842 CONCOR 10MG TAB (MEK) BISOPROLOL BISOPROLOL CONCOR 30'S C 30.28 1.01 TAB 30 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 2841AK GLUCOPHAGE 500MG TAB (MEK/COL) METFORMIN METFORMIN GLUCOPHAGE 100'S C 7.96 0.08 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD B 682004 BIGUANIDES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2841AK GLUCOPHAGE 500MG TAB (MEK) METFORMIN (C) METFORMIN GLUCOPHAGE 100'S C 7.96 0.0796 TAB 180 BOX MEK MERCK SERONO COL COLLINS LTD B 682004 BIGUANIDES 2024-04-01 2026-03-31 ORAL 6 BIGUANIDES
42 2841AK GLUCOPHAGE 500MG TAB (MEK) METFORMIN METFORMIN GLUCOPHAGE 100'S A 8.75 0.09 TAB 180 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 682004 BIGUANIDES 2026-04-01 ORAL 6 BIGUANIDES
40 2841T GLUCOPHAGE XR 500MG TAB (MEK/COL) METFORMIN X METFORMIN XR GLUCOPHAGE XR 30'S C 21.75 0.73 TABLET 0 TAB MEK MERCK SERONO COL COLLINS LTD B 682004 BIGUANIDES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 2841T GLUCOPHAGE 500MG XR TAB (MEK) METFORMIN XR (C) METFORMIN XR GLUCOPHAGE 30'S C 21.75 0.7249 TABXR 120 BOX MEK MERCK SERONO COL COLLINS LTD B 682004 BIGUANIDES 2024-04-01 2026-03-31 ORAL 6 BIGUANIDES
42 2841T GLUCOPHAGE 500MG XR TAB (MEK) METFORMIN XR METFORMIN XR GLUCOPHAGE 30'S C 22.18 0.74 TABXR 120 BLIS MEK MERCK SERONO COL AVENTA BARBADOS B 682004 BIGUANIDES 2026-04-01 ORAL 6 BIGUANIDES
40 28422 GLUCOPHAGE 850MG TAB (MEK/COL) METFORMIN METFORMIN GLUCOPHAGE 100'S C 16.36 0.16 TABLET 60 TAB MEK MERCK SERONO COL COLLINS LTD B 682004 BIGUANIDES 2022-08-25 2024-03-31 Add to Contract as Cat C Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES 2022-08-25