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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 0131DH KLARICID 50MG/ML SUSP (ABB/PHA) CLARITHROMYCI CLARITHROMYCIN KLARICID 60ML C $15.79 $0.26 SUSPENSION 0 ML ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131DH KLARICID 50MG/ML SUSP (ABB/PHA) CLARITHROMYCI (C) CLARITHROMYCIN KLARICID 60ML C $15.79 $0.26 SUSPENSION ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 8121292 OTHER MACROLIDES 2022-04-01 2023-03-31 Delete from contract Oral 0 OTHER MACROLIDES 2023-03-02
40 0131DJ KLARICID 25MG/ML SUSP (ABB/PHA) CLARITHROMYCI CLARITHROMYCIN KLARICID 60ML C $11.50 $0.19 SUSPENSION 0 ML ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131DJ KLARICID 25MG/ML SUSP (ABB/PHA) CLARITHROMYCI (C) CLARITHROMYCIN KLARICID 60ML C $11.50 $0.19 SUSPENSION ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 8121292 OTHER MACROLIDES 2022-04-01 2023-03-31 Delete from contract Oral 0 OTHER MACROLIDES 2023-03-02
40 0141FU KLARICID XL 500MG TAB (ABB/PHA) CLARITHROMYCI CLARITHROMYCIN KLARICID XL 10'S C $16.66 $1.67 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0141FU KLARICID XL 500MG TAB (ABB/PHA) CLARITHROMYCI (C) CLARITHROMYCIN KLARICID XL 10'S C $16.66 $1.67 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 8121292 OTHER MACROLIDES 2022-04-01 2023-03-31 Delete from contract Oral 0 OTHER MACROLIDES 2023-03-02
40 0141FV KLARICID 500MG TAB (ABB/PHA) CLARITHROMYCIN CLARITHROMYCIN KLARICID 10'S C $16.72 $1.67 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Price Change Oral 0 ANTI-INFECTIVE AGENTS 2022-05-05
40 0211Y MEROPENEM 500MG INJ (ABB/PHA) MEROPENEM MEROPENEM 500MG VIAL BQ $11.50 $11.50 INJECTION 0 VIAL ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 08120708 CARBAPENEMS 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS
40 0211Y MEROPENEM 500MG INJ (ABB/PHA) (BQ) MEROPENEM MEROPENEM 500MG VIAL BQ $11.50 $11.50 INJECTION ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 8120708 CARBAPENEMS 2022-04-01 2023-03-31 Delete from contract IV 6 CARBAPENEMS 2023-03-02
40 1261L ULTANE (4456-02) (ABB/PHA) SEVOFLURANE SEVOFLURANE ULTANE (4456-02) 250ML BQ $265.04 $265.04 SOLUTION 0 BOTT ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 280416 INHALATION ANAESTHETICS 2022-04-01 2024-03-31 INHALATION 0 CENTRAL NERVOUS SYSTEM DRUGS
40 2962R POST DAY 1.5MG TAB (ABB/PHA) LEVONORGESTREL LEVONORGESTREL POST DAY 1'S C $9.89 $9.89 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6812 CONTRACEPTIVES 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2962R POST DAY 1.5MG TAB (ABB/PHA) LEVONORGESTREL (C) LEVONORGESTREL POST DAY 1'S C $9.89 $9.89 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 6832 PROGESTINS 2022-04-01 2023-04-13 Delete from contract Oral 0 PROGESTINS 2023-03-02
40 2991Q SYNTHROID 0.1MG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C $7.75 $0.26 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2991Q SYNTHROID 0.1MG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C $7.75 $0.26 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2002-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C $5.71 $0.19 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C $5.71 $0.19 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C $7.29 $0.24 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C $7.29 $0.24 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE THYROXINE SYNTHROID 30'S C $7.39 $0.25 TABLET 0 TAB ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE (C) THYROXINE SYNTHROID 30'S C $7.39 $0.25 TABLET IMMED ABB ABBOTT PHA PHARMACY SALES CARIBBEAN 683604 THYROID AGENTS 2022-04-01 2023-03-31 Delete from contract Oral 0 THYROID AGENTS 2023-03-02