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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
42 4043A BSS (BAG) SOLN (ALC) BALANCED SALT BALANCED SALT BSS (BAG) 500ML BQ 32.10 32.10 BAG 10 BAG ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
40 40517 POENCANIA 0.5% EYE DR (LPO/COL) PROPARACAINE PROPARACAINE POENCANIA 10ML A 8.43 8.43 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5216 EENT LOCAL ANESTHETIC 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE PROPARACAINE P-CAINE 5ML A 3.13 3.1261 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5216 EENT LOCAL ANESTHETIC 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT LOCAL ANESTHETIC
42 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE PROPARACAINE P-CAINE 5ML A 3.26 3.26 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5216 EENT LOCAL ANESTHETIC 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT LOCAL ANESTHETIC
40 40613 ALLEREX 0.05% | 0.04% EYE DR (ASL/PHA) ANTAZOLI ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 5.79 5.79 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOL ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 8.81 8.8074 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT VASOCONSTRICTORS
42 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOLINE|TETRAHYDROZOLINE ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 8.13 8.13 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT VASOCONSTRICTORS
41 4061F OPTICOOL 0.05%|0.12% EYE DR (SHC) NAPHAZOLINE|PHENYLEPHRINE NAPHAZOLINE|PHENYLEPHRINE OPTICOOL 10ML A 3.59 3.5882 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT VASOCONSTRICTORS
42 4061H ANTAZOLINE|NAPHAZOLINE 0.5%|0.05% EYE DR (FSB) ANTAZOLINE|NAPHAZOLINE ANTAZOLINE|NAPHAZOLINE 10ML A 6.14 6.14 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 5232 EENT VASOCONSTRICTORS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT VASOCONSTRICTORS 2026-03-05
40 40712 TIMOLOL EX 0.25% EYE DR (FSB/ATB) TIMOLOL EX TIMOLOL EX 5ML A 1.09 1.09 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Price Change Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2021-12-08
42 40713 OPTIMOL 0.25% EYE DR (ASL) TIMOLOL TIMOLOL OPTIMOL 5ML A 8.16 8.15 BOTT 2 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 524008 EENT BETA ADRENERGIC AGENTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS
40 4073X POENTIMOL 0.5% EYE DR (LPO/COL) TIMOLOL TIMOLOL POENTIMOL 5ML C 5.44 5.44 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Add to Contract as Cat C OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-04-01
40 4074AG TIMOLOL 0.25% EYE DR (FSB/ATB) TIMOLOL TIMOLOL 10ML A 1.60 1.60 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Price Change Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2021-12-08
41 4074AG TIMOLOL 0.25% EYE DR (FSB) TIMOLOL TIMOLOL 10ML A 1.66 1.6582 BOTT 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS
42 4074AH TIMOLOL 0.25% EYE DR (FSB) TIMOLOL TIMOLOL 10ML A 1.36 1.36 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD B 524008 EENT BETA ADRENERGIC AGENTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS 2026-03-05
40 40919 GLYCEROL ADULT 4G SUPPOS (MTP/COL) GLYCERINE GLYCERINE GLYCEROL ADULT 12'S A 4.62 0.39 SUPPOSITORY 12 SUPP MTP MARTINDALE PHARMACEUTICALS COL COLLINS LTD 5612 CATHARTICS AND LAXATIVES 2022-06-02 2024-03-31 Add to Contract as Cat A RECTAL 6 GASTROINTESTINAL DRUGS 2022-06-02
40 4091R GLYCERINE ADULT 2G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE ADULT 12'S A 2.47 0.21 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 6 GASTROINTESTINAL DRUGS
42 4091S GLYCEROL 4G SUPPOS (MTP) GLYCERINE GLYCERINE GLYCEROL 12'S A 9.46 0.79 SUPP 12 BLIS MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2026-04-01 2028-03-31 RECTAL 6 CATHARTICS AND LAXATIVES
40 4092H GLYCERINE PAED 1G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE PAED 12'S A 2.88 0.24 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 0 GASTROINTESTINAL DRUGS
42 4092J GLYCEROL 1G SUPPOS (MTP) GLYCERINE GLYCERINE GLYCEROL 12'S A 7.96 0.66 SUPP 12 BLIS MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2026-04-01 2028-03-31 RECTAL 0 CATHARTICS AND LAXATIVES