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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 1791D POLYBAR ACB 100% (EZM/COL) BARIUM SULPHATE BARIUM SULPHATE POLYBAR ACB 24X397G BQ 1,250.43 52.10 SUSPENSION 0 KIT EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 Oral 0 DIAGNOSTIC AGENTS
41 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE BARIUM SULPHATE POLYBAR ACB 24X397G BQ 1375.47 57.3113 KIT 50 BOX EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 ORAL 0 ROENTGENOGRAPHY
42 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE BARIUM SULPHATE POLYBAR ACB 24X397G BQ 1,443.43 60.14 KIT 50 BOX EZM E-Z-EM INC. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 ORAL 0 ROENTGENOGRAPHY
40 1794C E-Z-HD 250% SUSP (EZM/COL) BARIUM SULPHATE BARIUM SULPHATE E-Z-HD 24X340G BQ 1,147.13 47.80 SUSPENSION 0 CUP EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 Oral 0 DIAGNOSTIC AGENTS
41 1794C E-Z-HD 250% SUSP (EZM) BARIUM SULPHATE BARIUM SULPHATE E-Z-HD 24X340G BQ 1261.3 52.5543 CUP 0 BOX EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 ORAL 0 ROENTGENOGRAPHY
42 1794C E-Z-HD 250% SUSP (EZM) BARIUM SULPHATE BARIUM SULPHATE E-Z-HD 24X340G BQ 1,323.82 55.16 CUP 0 BOX EZM E-Z-EM INC. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 ORAL 0 ROENTGENOGRAPHY
40 1795C READI-CAT 2 2% SUSP (EZM/COL) BARIUM SULPHATE BARIUM SULPHATE READI-CAT 2 12X450ML BQ 557.26 46.44 SUSPENSION 0 BOTT EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 Oral 0 DIAGNOSTIC AGENTS
41 1795C READI-CAT 2 2% SUSP (EZM) BARIUM SU BARIUM SULPHATE READI-CAT 2 12X450ML BQ 611.62 50.9686 BOX 0 BOTT EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 ORAL 0 ROENTGENOGRAPHY
42 1795C READI-CAT 2% SUSP (EZM) BARIUM SULPHATE BARIUM SULPHATE READI-CAT 12X450ML BQ 641.52 53.46 BOX 0 BOTT EZM E-Z-EM INC. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 ORAL 0 ROENTGENOGRAPHY
40 68911 E-Z-GAS II (EZM/COL) SOD BIC/CIT ACID/SIMET CITRIC ACID|SIMETHICONE|SODIUM BICARBONATE E-Z-GAS II 50X4G BQ 462.12 9.24 0 SACH EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2022-04-01 2024-03-31 Oral 0 DIAGNOSTIC AGENTS
41 68911 E-Z-GAS II (EZM) SOD BIC/CIT ACID/SIME (BQ) CITRIC ACID|SIMETHICONE|SODIUM BICARBONATE E-Z-GAS II 50X4G BQ 508.33 10.1665 SACH 0 BOX EZM E-Z-EM INC. COL COLLINS LTD 3668 ROENTGENOGRAPHY 2024-04-01 2026-03-31 ORAL 0 ROENTGENOGRAPHY
42 68911 E-Z-GAS II (EZM) SOD BIC/CIT ACID/SIME CITRIC ACID|SIMETHICONE|SODIUM BICARBONATE E-Z-GAS II 50X4G BQ 532.79 10.66 SACH 0 BOX EZM E-Z-EM INC. COL AVENTA BARBADOS 3668 ROENTGENOGRAPHY 2026-04-01 ORAL 0 ROENTGENOGRAPHY