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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 0012V CETIRIZINE 10MG TAB (HEA/RXP) CETIRIZINE CETIRIZINE 1X10 A 0.95 0.10 TABLET 14 TAB HEA HEALTH 2000 INC RXP RX PRO INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0012VB CETIRIZINE 10MG TAB (HEA/ATB) CETIRIZINE CETIRIZINE 1X10 A 0.95 0.095 TABLET IMMED HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-07 2024-03-31 Change Local Agent oral 0 SECOND GENERATION ANTIHISTAMINES 2022-11-25
42 0013BT CETIRIZINE 1MG/ML SOLN (HEA) CETIRIZINE CETIRIZINE 60ML A 2.83 0.05 ML 60 BOTT HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Price Change ORAL 0 SECOND GENERATION ANTIHISTAMINES 2025-10-31
42 0013BU LORATADINE 1MG/ML SOLN (HEA) LORATADINE LORATADINE 100ML A 3.13 0.03 ML 60 BOTT HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 0404 FIRST GENERATION ANTIHISTAMINES 2026-04-01 ORAL 0 FIRST GENERATION ANTIHISTAMINES
42 0013BX CETIRIZINE 1MG/ML SYR (HEA) CETIRIZINE CETIRIZINE 60ML A 2.83 0.05 ML 60 BOTT HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-01-26
42 0013BY LORATADINE 1MG/ML SYR (HEA) LORATADINE LORATADINE 100ML A 3.10 0.03 ML 120 BOTT HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-01-26
42 0013BZ CETIRIZINE 1MG/ML SYR (HEA) CETIRIZINE CETIRIZINE 60ML A 2.83 0.05 ML 60 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-26
42 0013CA LORATADINE 1MG/ML SYR (HEA) LORATADINE LORATADINE 100ML A 3.10 0.03 ML 120 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Add to Contract as Cat A ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-26
40 0013K CETIRIZINE 1MG/ML SYR (HEA/RXP) CETIRIZINE CETIRIZINE 60ML A 2.69 0.04 SYRUP 60 ML HEA HEALTH 2000 INC RXP RX PRO INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0013KA CETIRIZINE 1MG/ML SYR (HEA/ATB) CETIRIZINE CETIRIZINE 60ML A 2.69 0.0448 SYRUP HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-07 2024-03-31 Change Local Agent oral 0 SECOND GENERATION ANTIHISTAMINES 2022-11-25
41 0013KA CETIRIZINE 1MG/ML SYR (HEA) CETIRIZINE CETIRIZINE 60ML A 2.91 0.0485 ML 60 BOTT HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 0013P LORATADINE 1MG/ML SYRUP (HEA/RXP) LORATADINE LORATADINE 100ML A 3.13 0.03 SYRUP 120 ML HEA HEALTH 2000 INC RXP RX PRO INC 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0013PF LORATADINE 1MG/ML SYRUP (HEA/ATB) LORATADINE LORATADINE 100 ML A 3.13 0.0313 SYRUP HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-07 2024-03-31 Change Local Agent ORAL 0 SECOND GENERATION ANTIHISTAMINES 2022-11-25
41 0013PF LORATADINE 1MG/ML SYR (HEA) LORATADINE LORATADINE 100ML A 3.18 0.0318 ML 120 BOTT HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 01027 NYSTATIN 100,000U/ML SUSP (HEA/RXP) NYSTATIN NYSTATIN 60ML A 5.71 0.10 SUSPENSION 180 ML HEA HEALTH 2000 INC RXP RX PRO INC 081428 POLYENES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 0102AA NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-01-26
42 0102AC NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081428 POLYENES 2026-04-01 Add to Contract as Cat A ORAL 0 POLYENES 2026-02-26
40 0102V NYSTATIN 100,000U/ML SUSP (HEA/ATB) NYSTATIN NYSTATIN 60ML A 5.71 0.0952 SUSPENSION HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 81428 POLYENES 2022-12-07 2024-03-31 Change Local Agent ORAL 0 POLYENES 2022-11-25
41 0102V NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.76 0.096 ML 180 BOTT HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 081428 POLYENES 2024-04-01 2026-03-31 ORAL 0 POLYENES
42 0102Z NYSTATIN 100,000U/ML SUSP (HEA) NYSTATIN NYSTATIN 60ML A 5.65 0.09 ML 180 BOTT HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 081428 POLYENES 2026-04-01 Price Change ORAL 0 POLYENES 2025-10-31