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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 13911 SUFREXAL 2% GEL (JAC/STO) KETANSERIN KETANSERIN SUFREXAL 78G C 49.80 49.80 GEL 0 GEL JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 13911 SUFREXAL 2% GEL (JAC) KETANSERIN KETANSERIN SUFREXAL 78G C 49.8 49.7997 GEL 0 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2024-04-01 2026-03-31 TOPICAL 0 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
42 13911 SUFREXAL 2% GEL (JAC) KETANSERIN KETANSERIN SUFREXAL 78G C 49.80 49.80 TUBE 0 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2026-04-01 TOPICAL 0 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
40 1644T HALDOL 5MG TAB (JAC/STO) HALOPERIDOL HALOPERIDOL HALDOL 20'S C 32.27 1.61 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 28160808 BUTYROPHENES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 1644T HALDOL 5MG TAB (JAC) HALOPERIDOL (C) HALOPERIDOL HALDOL 20'S C 32.27 1.6133 TAB 180 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 28160808 BUTYROPHENES 2024-04-01 2026-03-31 ORAL 6 BUTYROPHENES
40 17231 CONCERTA 18MG TAB (JAC/STO) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 130.43 4.35 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLP (C) METHYLPHENIDATE CONCERTA 30'S C 130.43 4.3477 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-04-01 2024-06-20 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-18
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S A 130.43 4.3477 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-21 2024-07-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-18
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLP (C) METHYLPHENIDATE CONCERTA 30'S C 130.43 4.3477 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-08-01 2024-12-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-08-01
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S A 130.43 4.3477 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2025-01-01 2025-01-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-12-31
42 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 130.43 4.35 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 282032 RESPIRATORY-CNS STIMULANTS 2026-04-01 ORAL 6 RESPIRATORY-CNS STIMULANTS
40 17241 CONCERTA 27MG TAB (JAC/STO) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 156.82 5.23 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLP (C) METHYLPHENIDATE CONCERTA 30'S C 156.82 5.2273 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-04-01 2024-06-20 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-18
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S A 156.82 5.2273 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-21 2024-07-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-06-18
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLP (C) METHYLPHENIDATE CONCERTA 30'S C 156.82 5.2273 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-08-01 2024-12-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-08-01
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S A 156.82 5.2273 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2025-01-01 2025-01-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS 2024-12-31
42 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 156.82 5.23 TABER 30 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 282032 RESPIRATORY-CNS STIMULANTS 2026-04-01 ORAL 6 RESPIRATORY-CNS STIMULANTS
40 17251 CONCERTA 36MG TAB (JAC/STO) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 191.07 6.37 TABLET 0 TAB JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
41 17251 CONCERTA 36MG ER TAB (JAC) METHYLPHENIDATE (C) METHYLPHENIDATE CONCERTA 30'S C 191.07 6.369 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 2820 RESPIRATORY-CEREBRAL STIMULANTS 2024-04-01 2026-03-31 ORAL 6 RESPIRATORY-CEREBRAL STIMULANTS
42 17251 CONCERTA 36MG ER TAB (JAC) METHYLPHENIDATE METHYLPHENIDATE CONCERTA 30'S C 191.07 6.37 TABER 42 BOTT JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 282032 RESPIRATORY-CNS STIMULANTS 2026-04-01 ORAL 6 RESPIRATORY-CNS STIMULANTS