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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
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
40 01261 CHLORAMPHENICOL MINIMS 0.5% EYE DR (CAM/STO) CHLORAMPHENICOL CHLORAMPHENICOL MINIMS 20X0.5ML BQ $94.73 $4.74 EYE DROP 0 AMP CAM MORNINGSIDE PHARMACEUTICALS STO BRYDEN STOKES LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 0131U ZITHROMAX 40MG/ML SUSP (PFI/STO) AZITHROMYCIN AZITHROMYCIN ZITHROMAX 15ML C $29.66 $1.98 SUSPENSION 0 ML PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0141AH ZITHROMAX 500MG TAB (PFI/STO) AZITHROMYCIN AZITHROMYCIN ZITHROMAX 3'S C $53.01 $17.67 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
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 0211AG MERREM 500MG INJ (PFI/STO) MEROPENEM MEROPENEM MERREM 10X500MG C $561.20 $56.12 INJECTION 0 VIAL PFI PFIZER CORPORATION 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
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 0212BE MERREM 1G INJ (PFI/STO) MEROPENEM MEROPENEM MERREM 10X1G C $968.73 $96.87 INJECTION 0 VIAL PFI PFIZER CORPORATION 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
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
40 04612 SALAZOPYRINE E.C. 500MG TAB (PFI/STO) SULPHAS SULPHASALAZINE SALAZOPYRINE E.C. 100'S C $70.24 $0.70 TABLET 0 TAB PFI PFIZER CORPORATION STO BRYDEN STOKES LTD 081220 SULPHONAMIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0531V IMURAN 50MG TAB (ASG/STO) AZATHIOPRINE AZATHIOPRINE IMURAN 100'S C $174.27 $1.74 TABLET 0 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
40 05743 ENDOXAN 50MG TAB (BAX/STO) CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE ENDOXAN 50'S B $0.95 $0.02 TABLET 0 TAB BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
40 05756 ENDOXAN 1G INJ (BAX/STO) CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE ENDOXAN 1G VIAL BQ $15.96 $15.96 INJECTION 0 VIAL BAX BAXTER EXPORT CORP. STO BRYDEN STOKES LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 0621C PURINETHOL 50MG TAB (ASG/STO) MERCAPTOPURINE MERCAPTOPURINE PURINETHOL 25'S A $104.38 $4.18 TABLET 60 TAB ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD B 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
40 07127 ATROPINE MINIMS 1% EYE DR (CAM/STO) ATROPINE SULPHATE ATROPINE SULPHATE ATROPINE MINIMS 20X0.5ML B $94.73 $4.74 EYE DROP 0 AMP CAM MORNINGSIDE PHARMACEUTICALS STO BRYDEN STOKES LTD 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE/STO) TIOTRO TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ $111.29 $111.29 INHALER 0 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
40 09118 SPIOLTO RESPIMAT 2.5/2.5MCG INHR (BOE/STO) TI OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ $111.29 $111.29 INHALER 1 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS