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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 0012AB ALLEGRA 120MG TAB (SFA/COL) FEXOFENADINE FEXOFENADINE ALLEGRA 10'S C 9.51 0.95 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0012AB ALLEGRA 120MG TAB (SFA/COL) FEXOFENADIN (C) FEXOFENADINE ALLEGRA 10'S C 16.31 1.631 TABLET IMMED SFA SANOFI AVENTIS COL COLLINS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-10 2024-03-31 Price Change Oral 0 SECOND GENERATION ANTIHISTAMINES 2022-12-09
40 0012AQ ALLEGRA 180MG TAB (SFA/COL) FEXOFENADINE FEXOFENADINE ALLEGRA 10'S C 10.19 1.02 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0012AQ ALLEGRA 180MG TAB (SFA/COL) FEXOFENADIN (C) FEXOFENADINE ALLEGRA 10'S C 24.19 2.419 TABLET IMMED SFA SANOFI AVENTIS COL COLLINS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-10 2024-03-31 Price Change Oral 0 SECOND GENERATION ANTIHISTAMINES 2022-12-09
40 0013G ALLEGRA 6MG/ML SUSP (SFA/COL) FEXOFENADINE FEXOFENADINE ALLEGRA 150ML C 13.59 0.09 SUSPENSION 0 ML SFA SANOFI AVENTIS COL COLLINS LTD 0408 SECOND GENERATION ANTIHISTAMINES 2022-04-01 2024-03-31 Oral 0 ANTIHISTAMINICS
40 0013G ALLEGRA 6MG/ML SUSP (SFA/COL) FEXOFENAD (C) FEXOFENADINE ALLEGRA 150ML C 29.36 0.1957 SUSPENSION SFA SANOFI AVENTIS COL COLLINS LTD 408 SECOND GENERATION ANTIHISTAMINES 2022-12-10 2024-03-31 Price Change Oral 0 SECOND GENERATION ANTIHISTAMINES 2022-12-09
40 0481A FLAGYL 400MG TAB (SFA/COL) METRONIDAZOLE METRONIDAZOLE FLAGYL 14'S A 5.44 0.39 TABLET 90 TAB SFA SANOFI AVENTIS COL COLLINS LTD 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 07211 CALCORT 6MG TAB (SFA/COL) DEFLAZACORT DEFLAZACORT CALCORT 10'S C 27.18 2.72 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 07221 CALCORT 30MG TAB (SFA/COL) DEFLAZACORT DEFLAZACORT CALCORT 10'S C 38.06 3.81 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 0751N BUSCOPAN 10MG TAB (SFA/COL) HYOSCINE BUTYLBRO HYOSCINE BUTYLBROMIDE BUSCOPAN 100'S C 32.62 0.33 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 120808 ANTIMUSCARINICS/ANTISPASMODICS 2022-04-01 2024-03-31 Oral 0 AUTONOMIC DRUGS
40 0752L BUSCOPAN 20MG/ML INJ (SFA/COL) HYOSCINE BUTYL HYOSCINE BUTYLBROMIDE BUSCOPAN 10X1ML C 20.39 2.04 INJECTION 0 AMP SFA SANOFI AVENTIS COL COLLINS LTD 120808 ANTIMUSCARINICS/ANTISPASMODICS 2022-04-01 2024-03-31 IV 0 AUTONOMIC DRUGS
40 0752L BUSCOPAN 20MG/ML INJ (SFA/COL) HYOSCINE BUTYL (C) HYOSCINE BUTYLBROMIDE BUSCOPAN 10X1ML C 26.37 2.637 INJECTION SFA SANOFI AVENTIS COL COLLINS LTD 1208 ANTICHOLINERGIC AGENTS 2022-12-10 2024-03-31 Price Change IV 0 ANTICHOLINERGIC AGENTS 2022-12-09
40 13511 BARALGIN 500MG TAB (SFA/COL) METAMIZOL METAMIZOL BARALGIN 50'S C 23.76 0.48 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 13522 BARALGIN M 500MG/ML DROPS (SFA/COL) METAMIZOL METAMIZOL BARALGIN M 10ML A 8.15 8.15 DROPS 1 BOTT SFA SANOFI AVENTIS COL COLLINS LTD 280892 ANALGESICS AND PYRETICS MISCELLANEOUS 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 16111 TAXOTERE 20MG INJ (SFA/COL) DOCETAXEL DOCETAXEL TAXOTERE 20MG VIAL C 135.92 135.92 INJECTION 0 VIAL SFA SANOFI AVENTIS COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 16121 TAXOTERE 80MG INJ (SFA/COL) DOCETAXEL DOCETAXEL TAXOTERE 80MG VIAL C 231.06 231.06 INJECTION 0 VIAL SFA SANOFI AVENTIS COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 IV 0 ANTINEOPLASTICS
40 16814 STEMETIL 5MG TAB (SFA/COL) PROCHLORPER PROCHLORPERAZINE STEMETIL 25'S C 12.78 0.51 TABLET 0 TAB SFA SANOFI AVENTIS COL COLLINS LTD 28160824 PHENOTHIAZINES 2022-04-01 2024-03-31 Oral 0 CENTRAL NERVOUS SYSTEM DRUGS
40 2131B LASIX 40MG TAB (SFA/COL) FRUSEMIDE FRUSEMIDE LASIX 250'S A 24.46 0.10 TABLET 180 TAB SFA SANOFI AVENTIS COL COLLINS LTD B 402808 LOOP DIURETICS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE
41 2131B LASIX 40MG TAB (SFA) FRUSEMIDE FRUSEMIDE LASIX 250'S A 51.65 0.2066 TAB 180 BOX SFA SANOFI AVENTIS COL COLLINS LTD B 402808 LOOP DIURETICS 2024-04-01 2026-03-31 ORAL 6 LOOP DIURETICS
40 21322 LASIX 10MG/ML INJ (SFA/COL) FRUSEMIDE FRUSEMIDE LASIX 5X2ML C 5.98 1.20 INJECTION 0 VIAL SFA SANOFI AVENTIS COL COLLINS LTD 402808 LOOP DIURETICS 2022-04-01 2024-03-31 IV 0 ELECTROLYTIC, CALORIC, AND WATER BALANCE