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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 1321G CODEINE PHOSPHATE 15MG TAB (TEV/COL) CODEINE PHOSPHATE CODEINE PHOSPHATE 28'S A 5.03 0.18 TABLET 112 TAB TEV TEVA UK LTD. COL COLLINS LTD 280808 OPIATE AGONISTS 2022-04-01 2024-03-31 Oral 2 CENTRAL NERVOUS SYSTEM DRUGS
41 1321G CODEINE PHOSPHATE 15MG TAB (TEV) CODEINE PHOSPHATE CODEINE PHOSPHATE 28'S A 4.7 0.168 TAB 112 BOX TEV TEVA UK LTD. COL COLLINS LTD 280808 OPIATE AGONISTS 2024-04-01 2026-03-31 ORAL 2 OPIATE AGONISTS
40 1322L CODEINE PHOSPHATE 30MG TAB (TEV/COL) CODEINE PHOSPHATE CODEINE PHOSPHATE 28'S A 6.85 0.24 TABLET 112 TAB TEV TEVA UK LTD. COL COLLINS LTD 280808 OPIATE AGONISTS 2022-04-01 2024-03-31 Oral 2 CENTRAL NERVOUS SYSTEM DRUGS
41 1322L CODEINE PHOSPHATE 30MG TAB (TEV) CODEINE PHOSPHATE CODEINE PHOSPHATE 28'S A 5.76 0.2058 TAB 112 BOX TEV TEVA UK LTD. COL COLLINS LTD 280808 OPIATE AGONISTS 2024-04-01 2026-03-31 ORAL 2 OPIATE AGONISTS
40 15011 PHENOBARBITAL 15MG TAB (TEV/COL) PHENOBARBITO PHENOBARBITONE PHENOBARBITAL 28'S A 42.54 1.52 TABLET 180 TAB TEV TEVA UK LTD. COL COLLINS LTD B 281204 BARBITURATES (ANTICONVULSANTS) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 1601J DIAZEPAM 2MG TAB (TEV/COL) DIAZEPAM DIAZEPAM 28'S A 2.50 0.09 TABLET 120 TAB TEV TEVA UK LTD. COL COLLINS LTD 282408 BENZODIAZEPINES (SEDATIVES) 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
41 2451AQ LOPERAMIDE 2MG CAP (TEV) LOPERAMIDE LOPERAMIDE 30'S A 2.96 0.0988 CAP 30 BOTT TEV TEVA UK LTD. COL COLLINS LTD 5608 ANTIDIARRHEA AGENTS 2024-04-01 2024-12-16 ORAL 6 ANTIDIARRHEA AGENTS
41 2451AQ LOPERAMIDE 2MG CAP (TEV) LOPERAMIDE LOPERAMIDE 30'S A 4.57 0.1523 CAP 30 BOTT TEV TEVA UK LTD. COL COLLINS LTD 5608 ANTIDIARRHEA AGENTS 2024-12-17 2026-03-31 ORAL 6 ANTIDIARRHEA AGENTS 2024-11-26
41 2681A HYDROCORTISONE 10MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 9.24 0.3081 TAB 120 BOTT TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-04-01 2024-12-16 ORAL 6 ADRENALS
41 2681A HYDROCORTISONE 10MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 17.59 0.5863 TAB 120 BOTT TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-12-17 2026-03-31 ORAL 6 ADRENALS 2024-11-26
41 26827 HYDROCORTISONE 20MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 17.83 0.5944 TAB 120 BOX TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-04-01 2024-12-16 ORAL 6 ADRENALS
41 26827 HYDROCORTISONE 20MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 19.95 0.665 TAB 120 BOX TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-12-17 2026-03-31 ORAL 6 ADRENALS 2024-11-26
41 5814F VERAPAMIL 40MG TAB (TEV) VERAPAMIL VERAPAMIL 84'S A 6.61 0.0786 TAB 90 BOTT TEV TEVA UK LTD. COL COLLINS LTD B 242892 CCBs, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 CCBs, MISCELLANEOUS
41 A992P TOLTERODINE XL 2MG SR TAB (TEV) (C) TOLTERODINE TOLTERODINE XL 28'S C 12.56 0.4485 TABSR 0 BOTT TEV TEVA UK LTD. COL COLLINS LTD 1208 ANTICHOLINERGIC AGENTS 2024-04-01 2026-03-31 ORAL 0 ANTICHOLINERGIC AGENTS