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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 91331 ALCOHOL SMALL (WIR/WIR) ALCOHOL ALCOHOL 1 LITRE B 6.20 0.01 MILILITRE 0 ML WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Price Change TOPICAL 0 UNCLASSIFIED THERAPEUTIC AGENTS 2021-11-10
41 91331 ALCOHOL SMALL (WIR) ALCOHOL ALCOHOL ALCOHOL 1 LITRE B 7.26 0.0073 ML 1000 BOTT WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2024-04-01 2026-03-31 TOPICAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
42 91331 ALCOHOL SMALL (WIR) ALCOHOL ALCOHOL ALCOHOL 1 LITRE B 7.37 0.01 ML 1000 BOTT WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2026-04-01 TOPICAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
40 91341 ALCOHOL LARGE (WIR/WIR) ALCOHOL ALCOHOL 1 LITRE B 6.20 0.01 MILILITRE 0 ML WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2022-09-30 Price Change TOPICAL 0 UNCLASSIFIED THERAPEUTIC AGENTS 2021-11-10
41 91341 ALCOHOL LARGE (WIR) ALCOHOL ALCOHOL ALCOHOL 1 LITRE B 7.26 0.0073 ML 1000 BOTT WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2024-04-01 2026-03-31 TOPICAL 6 UNCLASSIFIED THERAPEUTIC AGENTS
42 91341 ALCOHOL LARGE (WIR) ALCOHOL ALCOHOL ALCOHOL 1 LITRE B 7.37 0.01 ML 1000 BOTT WIR WEST INDIES RUM DISTILLERY LTD. WIR WEST INDIES RUM DISTILLERY LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2026-04-01 TOPICAL 6 UNCLASSIFIED THERAPEUTIC AGENTS