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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
41 5281BV APROCIN 0.3% EYE DR (ARP) CIPROFLOXACIN (BH) CIPROFLOXACIN APROCIN 10ML BH 8.15 8.15 BOTT 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
41 5281BW FUSITHAL 1% EYE DR (ARP) FUSIDIC ACID FUSIDIC ACID FUSITHAL 5G A 10.57 10.5743 TUBE 1 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
42 5281BW FUSITHAL 1% EYE DR (ARP) FUSIDIC ACID FUSIDIC ACID FUSITHAL 5G A 10.57 10.57 TUBE 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
40 5281BX OPTIMOX 0.5% EYE DR (ARP/AHI) MOXIFLOXACIN MOXIFLOXACIN OPTIMOX 5ML BQ 8.70 8.70 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281BY T-MYCIN 0.3% EYE DR (ARP) TOBRAMYCI (BH) TOBRAMYCIN T-MYCIN 5ML BH 5.44 5.4366 BOTT 2 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5281CB TOBREX 0.3% EYE DR (NVS/COL) TOBRAMYCIN TOBRAMYCIN TOBREX 5ML C 23.30 23.30 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281CB TOBREX 0.3% EYE DR (NVS) TOBRAMYCIN (C) TOBRAMYCIN TOBREX 5ML C 16.31 16.3099 BOTT 2 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5281CC APO-GATIFLOXACIN 0.3% EYE DR (APO/COL) GATIFLOXACIN APO-GATIFLOXACIN 5ML BQ 9.51 9.51 EYE DROP 1 BOTT APO APOTEX INC. COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 5281CD VIGAMOX 0.5% EYE DR (NVS/COL) MOXIFLOXACIN MOXIFLOXACIN VIGAMOX 3ML C 27.05 27.05 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281CE VIGAMOX 0.5% EYE DR (NVS) MOXIFLOXACIN (C) MOXIFLOXACIN VIGAMOX 5ML C 45.4 45.396 BOTT 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
42 5281CE VIGAMOX 0.5% EYE DR (NVS) MOXIFLOXACIN MOXIFLOXACIN VIGAMOX 5ML C 45.40 45.40 BOTT 0 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
41 5281CF ENMOX 0.5% EYE DR (SHC) MOXIFLOXACIN (BQ) MOXIFLOXACIN ENMOX 5ML BQ 5.71 5.7085 BOTT 0 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
42 5281CR 4QUIN 0.5% EYE DR (ADO) MOXIFLOXACIN MOXIFLOXACIN 4 QUIN 5ML BQ 6.25 6.25 BOTT 0 BOTT ADO ADORE PHARMA PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
42 5281CS TOBRACID 0.3% EYE DR (SHC) TOBRAMYCIN TOBRAMYCIN TOBRACID 5ML C 2.77 2.77 BOTT 2 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5281P GOTABIOTIC 0.3% EYE DR (LPO/COL) TOBRAMY TOBRAMYCIN GOTABIOTIC 5ML BH 7.34 7.34 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281P GOTABIOTIC 0.3% EYE DR (LPO) TOBRAMYCIN (BH) TOBRAMYCIN GOTABIOTIC 5ML BH 7.42 7.421 BOTT 2 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
42 5281P GOTABIOTIC 0.3% EYE DR (LPO) TOBRAMYCIN TOBRAMYCIN GOTABIOTIC 5ML C 13.59 13.59 BOTT 2 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
41 5282E APROCIN 0.3% OINT (ARP) CIPROFLOXAC (BH) CIPROFLOXACIN APROCIN 3G BH 2.64 2.6368 TUBE 0 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 TOPICAL 0 EENT ANTIBACTERIALS
42 5282E APROCIN 0.3% OINT (ARP) CIPROFLOXAC CIPROFLOXACIN APROCIN 3G BH 2.72 2.72 TUBE 0 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2026-04-01 2028-03-31 TOPICAL 0 EENT ANTIBACTERIALS
40 5282F T-MYCIN 0.3% OINT (ARP/AHI) TOBRAMYCIN TOBRAMYCIN T-MYCIN 3G BH 10.00 10.00 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2022-09-30 TOPICAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29