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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 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE DIAGNOSTIC URINE MEDI-TEST COMBI 10 100'S B 15.22 15.22 STRIP 0 BOTT SCN SCANPHARM A/S PHA PHARMACY SALES CARIBBEAN 3688 URINE CONTENTS 2022-04-01 2022-07-18 0 DIAGNOSTIC AGENTS
40 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE DIAGNOSTIC URINE MEDI-TEST COMBI 10 100'S B 20.44 20.44 STRIP 0 BOTT SCN SCANPHARM A/S PHA PHARMACY SALES CARIBBEAN 3688 URINE CONTENTS 2022-07-19 2024-03-31 Price Change 0 DIAGNOSTIC AGENTS 2022-07-18
41 19415 MEDI-TEST COMBI 10 STRP (SCN) DIAGNOSTIC URINE (B) DIAGNOSTIC URINE MEDI-TEST COMBI 10 100'S B 25.1 25.1 BOTT 0 BOTT SCN SCANPHARM A/S PHA PHARMACY SALES CARIBBEAN 3688 URINE CONTENTS 2024-04-01 2026-03-31 0 URINE CONTENTS 2023-10-05
42 19415 MEDI-TEST COMBI 10 STRP (SCN) DIAGNOSTIC URINE DIAGNOSTIC URINE MEDI-TEST COMBI 10 100'S B 18.21 18.21 BOTT 0 BOTT SCN SCANPHARM A/S PHA PHARMACY SALES CARIBBEAN 3688 URINE CONTENTS 2026-04-01 0 URINE CONTENTS
40 1941G MEDI-TEST COMBI-10 STRP (SCN/PHA) DIAGNOSTIC URINE DIAGNOSTIC URINE MEDI-TEST COMBI-10 50'S B 15.22 15.22 STRIP 0 BOTT SCN SCANPHARM A/S PHA PHARMACY SALES CARIBBEAN 3688 URINE CONTENTS 2022-04-01 2024-03-31 0 DIAGNOSTIC AGENTS
40 19932 SODIUM CHLORIDE 0.45% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 4.15 4.15 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 19932 SODIUM CHLORIDE 0.45% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 5.30 5.30 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2022-07-18 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 19932 SODIUM CHLORIDE 0.45% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 3.77 3.77 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 19932 SODIUM CHLORIDE 0.45% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 1 LITRE B 3.7 3.6969 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 19944 SODIUM CHLORIDE 0.45% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 3.50 3.50 INJECTION 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 19944 SODIUM CHLORIDE 0.45% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 4.48 4.48 INJECTION 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
41 19944 SODIUM CHLORIDE 0.45% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.36 2.3649 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 19958 SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 250ML B 2.10 2.10 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 19958 SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 250ML B 2.64 2.64 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2022-07-18 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 19958 SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 250ML B 2.09 2.09 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 19958 SODIUM CHLORIDE 0.9% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 250ML B 2.12 2.1203 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY
40 1996H SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.40 2.40 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-04-01 2022-06-15 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2021-11-10
40 1996H SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 3.22 3.22 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-06-16 2022-07-27 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-06-15
40 1996H SODIUM CHLORIDE 0.9% INJ (CSC/PHA) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.53 2.53 INJECTION 0 BOTT CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4036 IRRIGATING SOLUTIONS 2022-07-19 2024-03-31 Price Change IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-07-18
41 1996H SODIUM CHLORIDE 0.9% INJ (CSC) (B) SODIUM CHLORIDE SODIUM CHLORIDE 500ML B 2.42 2.4193 BAG 0 BAG CSC FORSURE MEDICAL PHA PHARMACY SALES CARIBBEAN 4012 REPLACEMENT THERAPY 2024-04-01 2026-03-31 IV 0 REPLACEMENT THERAPY