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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 74712 DEPIXOL DEPOT 20MG/ML INJ (LUN/COL) FLUPENTHI FLUPENTHIXOL DEPIXOL DEPOT 10X1ML B 117.95 11.80 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 74715 CLOPIXOL ACUPHASE 50MG/ML(LUN/COL)ZUCLOPENTHI ZUCLOPENTHIXOL CLOPIXOL ACUPHASE 5X1ML C 105.53 21.11 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 74719 CLOPIXOL DEPOT 200MG/ML(LUN/COL)ZUCLOPENTHI ZUCLOPENTHIXOL CLOPIXOL DEPOT 10X1ML C 374.72 37.47 INJECTION 0 AMP LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 IV 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473C CLOPIXOL 10MG TAB (LUN/COL) ZUCLOPENTHIXOL ZUCLOPENTHIXOL CLOPIXOL 100'S C 485.22 4.85 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473J CLOPIXOL 2MG TAB (LUN/COL) ZUCLOPENTHIXOL ZUCLOPENTHIXOL CLOPIXOL 100'S C 485.22 4.85 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 7473K DEPIXOL 3MG TAB (LUN/COL) FLUPENTHIXOL FLUPENTHIXOL DEPIXOL 100'S A 115.09 1.15 TABLET 180 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160832 THIOXANTHENES 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 A322FQ LEXAPRO 10MG TAB (LUN/COL) ESCITALOPRAM ESCITALOPRAM LEXAPRO 28'S C 90.76 3.24 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322JU CIPRAMIL 20MG TAB (LUN/COL) CITALOPRAM CITALOPRAM CIPRAMIL 14'S C 48.09 3.44 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 A322KD LEXAPRO 20MG TAB (LUN/COL) ESCITALOPRAM ESCITALOPRAM LEXAPRO 14'S C 89.54 6.40 TABLET 0 TAB LUN H. LUNDBECK & CO. A/S COL COLLINS LTD 28160420 SELECTIVE SEROTONIN REUPTAKE INHIBITORS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS