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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 0012EY AERIUS 5MG TAB (MSD/STO) DESLORATADINE DESLORATADINE AERIUS 30'S C 24.95 0.83 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0012EY AERIUS 5MG TAB (MSD) DESLORATADINE (C) DESLORATADINE AERIUS 30'S C 25.2 0.84 TAB 0 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
42 0012EY AERIUS 5MG TAB (MSD) DESLORATADINE DESLORATADINE AERIUS 30'S C 25.20 0.84 TAB 0 BLIS MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 ORAL 0 SECOND GENERATION ANTIHISTAMINES
40 0013BK AERIUS 0.5MG/ML SYR (MSD/STO) DESLORATADINE DESLORATADINE AERIUS 60ML C 11.74 0.20 SYRUP 0 ML MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0013BK AERIUS 0.5MG/ML SYR (MSD) DESLORATADINE (C) DESLORATADINE AERIUS 60ML C 11.88 0.198 ML 60 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0404 FIRST GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 FIRST GENERATION ANTIHISTAMINES
42 0013BK AERIUS 0.5MG/ML SYR (MSD) DESLORATADINE DESLORATADINE AERIUS 60ML C 11.88 0.20 ML 60 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 0404 FIRST GENERATION ANTIHISTAMINES 2026-04-01 ORAL 0 FIRST GENERATION ANTIHISTAMINES
40 02112 INVANZ 1G INJ (MSD/STO) ERTAPENEM ERTAPENEM INVANZ 10X1G C 924.23 92.42 INJECTION 0 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 08120708 CARBAPENEMS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
40 0211T INVANZ 1G INJ (MSD/STO) ERTAPENEM (C) ERTAPENEM INVANZ 1GM C 92.42 92.42 INJECTION MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8120708 CARBAPENEMS 2023-03-20 2024-03-31 Add to Contract as Cat C IV/IM/SC CARBAPENEMS 2023-02-22
41 0211T INVANZ 1G INJ (MSD) ERTAPENEM (BQ) ERTAPENEM INVANZ 1GM BQ 82.66 82.66 VIAL 28 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 08120708 CARBAPENEMS 2024-04-01 2026-03-31 IV/IM/SC 1 CARBAPENEMS
40 02128 PRIMAXIN 500MG INJ (MSD/STO) IMIPENEM/CILASTA CILASTATIN|IMIPENEM PRIMAXIN 25X500MG BQ 665.99 26.64 INJECTION 0 VIAL MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 08120708 CARBAPENEMS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
40 02316 DULERA 5MCG | 100MCG INHR (MSD/STO) FORMOTEROL | MOMETASONE FORMOTEROL|MOMETASONE DULERA 120 DOSES B 56.68 56.68 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02316 DULERA 5MCG|100MCG INHR (MSD) FORMOTEROL|MOMETASONE (C) FORMOTEROL|MOMETASONE DULERA 120 DOSES C 58.39 58.3896 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 02326 DULERA 200MCG/5MCG INHR (MSD/STO) MOMETASONE/ FORMOTEROL|MOMETASONE DULERA 120 DOSES B 59.26 59.26 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02326 DULERA 200MCG/5MCG INHR (MSD) MOMETASONE (B) FORMOTEROL|MOMETASONE DULERA 120 DOSES B 61.03 61.0264 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2022-12-31 Delete from contract OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-12-31
40 3151C EZETROL 10MG TAB (MSD/STO) EZETIMIBE EZETIMIBE EZETROL 30'S C 47.30 1.58 TABLET 0 TAB MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 240605 CHOLESTEROL ABSORPTION INHIBITORS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 3151C EZETROL 10MG TAB (MSD) EZETIMIBE (C) EZETIMIBE EZETROL 30'S C 47.76 1.592 TAB 30 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 240605 CHOLESTEROL ABSORPTION INHIBITORS 2024-04-01 2026-03-31 ORAL 6 CHOLESTEROL ABSORPTION INHIBITORS
42 3151C EZETROL 10MG TAB (MSD) EZETIMIBE EZETIMIBE EZETROL 30'S C 47.76 1.59 TAB 30 BLIS MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 240605 CHOLESTEROL ABSORPTION INHIBITORS 2026-04-01 ORAL 6 CHOLESTEROL ABSORPTION INHIBITORS
40 3301BC ELOCOM 0.1% CR (MSD/STO) MOMETASONE MOMETASONE ELOCOM 15G C 10.11 10.11 CREAM 0 TUBE MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS