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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 0012Y ZYRTEC 10MG TAB (GSK/COL) CETIRIZINE CETIRIZINE ZYRTEC 20'S C 20.69 1.03 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0012Y ZYRTEC 10MG TAB (GSK) CETIRIZINE (C) CETIRIZINE ZYRTEC 20'S C 22.75 1.1376 TAB 14 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
42 0012Y ZYRTEC 10MG TAB (GSK) CETIRIZINE CETIRIZINE ZYRTEC 20'S C 25.23 1.26 TAB 14 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Price Change ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-16
40 0013AF ZYRTEC 10MG/ML DROPS (GSK/COL) CETIRIZINE CETIRIZINE ZYRTEC 10ML C 11.85 11.85 DROPS 0 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0013T ZYRTEC 1MG/ML SYR (GSK/COL) CETIRIZINE CETIRIZINE ZYRTEC 60ML C 11.20 0.19 SYRUP 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
41 0013T ZYRTEC 1MG/ML SYR (GSK) CETIRIZINE (C) CETIRIZINE ZYRTEC 60ML C 12.31 0.2052 ML 60 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2024-04-01 2026-03-31 ORAL 0 SECOND GENERATION ANTIHISTAMINES
42 0013T ZYRTEC 1MG/ML SYR (GSK) CETIRIZINE CETIRIZINE ZYRTEC 60ML C 13.67 0.23 ML 60 BOTT GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 0408 SECOND GENERATION ANTIHISTAMINES 2026-04-01 Price Change ORAL 0 SECOND GENERATION ANTIHISTAMINES 2026-02-16
40 0111S ZINNAT 500MG TAB (GSK/COL) CEFUROXIME CEFUROXIME ZINNAT 50'S C 145.62 2.91 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0112CH ZINNAT 50MG/ML SUSP (GSK/COL) CEFUROXIME CEFUROXIME ZINNAT 70ML C 25.66 0.26 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Package Size Change Oral 0 ANTI-INFECTIVE AGENTS 2022-03-21
40 0112ZG ZINNAT 25MG/ML SUSP (GSK/COL) CEFUROXIME CEFUROXIME ZINNAT 100ML C 28.11 0.28 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0112ZG ZINNAT 25MG/ML SUSP (GSK) CEFUROXIME CEFUROXIME ZINNAT 100ML BQ 25.66 0.2566 ML 21 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2024-04-01 2026-03-31 ORAL 0 SECOND GEN CEPHALOSPORINS
40 0114L ZINNAT 250MG TAB (GSK/COL) CEFUROXIME CEFUROXIME ZINNAT 50'S C 97.07 1.94 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 08120608 SECOND GEN CEPHALOSPORINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0152BF AMOXIL 25MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 11.47 0.11 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0152BF AMOXIL 25MG/ML SUSP (GSK) AMOXICILLIN (C) AMOXICILLIN AMOXIL 100ML C 12.61 0.1261 ML 300 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2024-04-01 2026-03-31 ORAL 0 PENICILLINS
42 0152BF AMOXIL 25MG/ML SUSP (GSK) AMOXICIL (C) AMOXICILLIN AMOXIL 100ML C 13.27 0.13 ML 300 BOTT GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 081216 PENICILLINS 2026-04-01 ORAL 0 PENICILLINS
40 0153CC AMOXIL 500MG CAP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100'S C 42.41 0.42 CAPSULE 0 CAP GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0153CC AMOXIL 500MG CAP (GSK) AMOXICILLIN (C) AMOXICILLIN AMOXIL 100'S C 46.65 0.4665 CAP 56 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2024-04-01 2026-03-31 ORAL 0 PENICILLINS
42 0153CC AMOXIL 500MG CAP (GSK) AMOXICILLIN (C) AMOXICILLIN AMOXIL 100'S C 48.98 0.49 CAP 56 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 081216 PENICILLINS 2026-04-01 ORAL 0 PENICILLINS
40 0155T AMOXIL 50MG/ML SUSP (GSK/COL) AMOXICILLIN AMOXICILLIN AMOXIL 100ML C 13.27 0.13 SUSPENSION 0 ML GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 0155T AMOXIL 50MG/ML SUSP (GSK) AMOXICILLIN (C) AMOXICILLIN AMOXIL 100ML C 14.6 0.146 ML 200 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 081216 PENICILLINS 2024-04-01 2026-03-31 ORAL 0 PENICILLINS