Displaying 1 - 20 of 99
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 0011M HISTAL 4MG TAB (CAR/COL) CHLORPHENIRAMINE CHLORPHENIRAMINE HISTAL 1000'S A $29.06 $0.03 TABLET 84 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0404 FIRST GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0012AN MEQUILAN 5MG TAB (CAR/COL) MEQUITAZINE MEQUITAZINE MEQUILAN 112'S A $42.41 $0.38 TABLET 28 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0013E HISTAL 0.4MG/ML ELIX (CAR/COL) CHLORPHENIRAMI CHLORPHENIRAMINE HISTAL 2 LITRES A $34.79 $0.02 SYRUP 100 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 0404 FIRST GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0292J CLINEX 150MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 3X10 A $9.65 $0.32 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0294K CLINEX 300MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 30'S A $18.76 $0.63 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0452E SULFATRIM 40MG/ML | 8MG/ML SUSP (CAR/COL) SULFAMETHOXAZOLE | TRIMETHOPRIM SULFAMETHOXAZOLE|TRIMETHOPRIM SULFATRIM 100ML A $5.84 $0.06 SUSPENSION 200 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 081220 SULPHONAMIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 07219 FLACORT 6MG TAB (ARP/AHI) DEFLAZACORT DEFLAZACORT FLACORT 3X10 C $8.97 $0.30 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 09712 IFA 40MG | 0.04MG SYR (CAR/COL) FERROUS SULPHAT FERROUS SULPHATE|FOLIC ACID IFA 125ML A $8.05 $0.06 SYRUP 375 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 200404 IRON PREPARATIONS 2022-04-01 2024-03-31 Oral 6 BLOOD FORMATION, COAGULATION AND THROMBOSIS
40 09911 IFA 200MG | 0.4MG TAB (CAR/COL) FERROUS SULPHATE | FOLIC ACID FERROUS SULPHATE|FOLIC ACID IFA 300'S C $36.53 $0.12 TABLET 0 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 200404 IRON PREPARATIONS 2022-04-01 2024-03-31 Oral 0 BLOOD FORMATION, COAGULATION AND THROMBOSIS
40 12148 NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN GLYCERYL TRINITRATE NITROCARD 200 DOSES A $17.61 $17.61 SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1421CF ARAMOL 500MG TAB (CAR/COL) PARACETAMOL PARACETAMOL ARAMOL 500'S A $14.78 $0.03 TABLET 180 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2022-06-30 2024-03-31 Add to Contract as Cat A Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-06-30
40 1422AB ARAMOL 32MG/ML SYR (CAR/COL) PARACETAMOL PARACETAMOL ARAMOL 125ML A $4.62 $0.04 SYRUP 300 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 16819 CARMETIC 5MG TAB (CAR/COL) PROCHLORPERAZINE PROCHLORPERAZINE CARMETIC 1000'S A $65.24 $0.07 TABLET 180 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 28160824 PHENOTHIAZINES 2022-04-01 2024-03-31 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS
40 20821 BEZIDE HS 2.5MG TAB (CAR/COL) BENDROFLUAZIDE BENDROFLUAZIDE BEZIDE HS 500'S A $16.31 $0.03 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402820 THIAZIDE DIURETICS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 2091B CARLIDONE 50MG TAB (CAR/COL) CHLORTHALIDONE CHLORTHALIDONE CARLIDONE 125's A $15.60 $0.12 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402824 THIAZIDE LIKE DIURETICS 2022-05-05 2024-03-31 Add to Contract as Cat A Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-05-05
40 2091C CARLIDONE 50MG TAB (CAR/COL) CHLORTHALIDONE CHLORTHALIDONE CARLIDONE 500'S A $59.99 $0.12 TABLET 30 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402824 THIAZIDE LIKE DIURETICS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 20926 CARLIDONE 25MG TAB (CAR/COL) CHLORTHALIDONE CHLORTHALIDONE CARLIDONE 125's A $15.60 $0.12 TABLET 60 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402824 THIAZIDE LIKE DIURETICS 2022-04-01 2024-03-31 Package Size Change Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE 2022-05-05
40 20927 CARLIDONE 25MG TAB (CAR/COL) CHLORTHALIDONE CHLORTHALIDONE CARLIDONE 750'S A $89.98 $0.12 TABLET 60 TAB CAR CARLISLE LABORATORIES LTD COL COLLINS LTD B 402824 THIAZIDE LIKE DIURETICS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40 2191M CODEINE 3MG/ML LINC (CAR/COL) CODEINE CODEINE 2 LITRES B $59.80 $0.03 SOLUTION 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4808 ANTITUSSIVES 2022-04-01 2024-03-31 Oral 0 RESPIRATORY TRACT AGENTS
40 22011 TUSCOSED EF SYR (CAR/COL) DIPHEN/COD.PHOS CODEINE|DIPHENHYDRAMINE TUSCOSED EF 2 LITRES B $75.00 $0.04 SYRUP 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 4808 ANTITUSSIVES 2022-04-01 2024-03-31 Oral 0 RESPIRATORY TRACT AGENTS