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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 6451AA MAXITROL 1MG/ML | 3MG/ML | 10,000U EYE DR (NVS/COL) DEXAMETHASONE | NEOMYCIN | P More ... DEXAMETHASONE|NEOMYCIN|POLYMYXIN B MAXITROL 5ML BQ 32.08 32.08 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 6451AE 4-QUIN D 0.1%|0.5% EYE DR (HAN) DEXAMETHASONE|MOXIFLOXACIN (BQ) DEXAMETHASONE|MOXIFLOXACIN 4-QUIN D 5ML BQ 3.94 3.9416 BOTT 1 BOTT HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 6451L QUIDEX EYE DROP (LPO/COL) CIPRO/DEXAM CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML B 8.15 8.15 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 6451L QUIDEX 0.3%|0.1% EYE DR (LPO) CIPROFLOXACIN|DEXAMETHASONE (BH) CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML BH 8.97 8.9705 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 6451L QUIDEX 0.3%|0.1% EYE DR (LPO) CIPROFLOXACIN|DEXAMETHASONE CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML B 16.31 16.31 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 6451M MAXISPORIN 1MG/ML | 3MG EYE DR (ASL/PHA) DEXAMETHASONE | NEOMYCIN | POLYMYXIN B DEXAMETHASONE|NEOMYCIN|POLYMYXIN B MAXISPORIN 5ML BQ 5.52 5.52 EYE DROP 0 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 6451R GATIDEX 0.1% | 0.3% EYE DR (LPO/COL) DEXAMETHASONE | GATIFLOXACIN DEXAMETHASONE|GATIFLOXACIN GATIDEX 5ML BQ 9.51 9.51 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 6451Y CIPRODEX 0.3% | 0.1% EAR DR (NVS/COL) CIPROFLOX CIPROFLOXACIN|DEXAMETHASONE CIPRODEX 7.5ML C 29.68 29.68 EAR DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 6451Z VIGADEXA 0.1% | 0.5% EYE DR (NVS/COL) DEXAMETHA DEXAMETHASONE|MOXIFLOXACIN VIGADEXA 5ML BQ 20.39 20.39 EYE DROP 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 6451Z VIGADEXA 0.1%|0.5% EYE DR (NVS) DEXAMETHASONE|MOXIFLOXACIN (C) DEXAMETHASONE|MOXIFLOXACIN VIGADEXA 5ML C 20.39 20.3874 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 6451Z VIGADEXA 0.1%|0.5% EYE DR (NVS) DEXAMETHASONE|MOXIFLOXACIN DEXAMETHASONE|MOXIFLOXACIN VIGADEXA 5ML C 20.39 20.39 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
41 64611 SULPHADIAZINE 500MG TAB (JOL) SILVER SULPHADIAZINE (C) SULPHASALAZINE SULPHADIAZINE 100'S C 76.47 0.7647 TAB 0 BOX JOL JOLLY PHARMACEUTICALS PHA PHARMACY SALES CARIBBEAN 081220 SULPHONAMIDES 2024-04-01 2026-03-31 ORAL 0 SULPHONAMIDES
42 64916 CALCIUM CHLORIDE 10% INJ (MTP) CALCIUM CHLORIDE CALCIUM CHLORIDE 10ML AMP B 40.99 40.99 AMPG 0 AMP MTP MARTINDALE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 4012 REPLACEMENT THERAPY 2026-04-01 IV 0 REPLACEMENT THERAPY
40 65216 PENTAMIDINE 300MG INJ (DIL/AHI) PENTAMIDINE PENTAMIDINE 10X15ML C 6,415.24 641.52 INJECTION 0 VIAL DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 083092 ANTIPROTOZOALS, MISCELLANEOUS 2022-04-01 2024-03-31 IV 0 ANTI-INFECTIVE AGENTS
40 6561D MESAGUT 400MG TAB (ARP/AHI) MESALAZINE MESALAZINE MESAGUT 30'S BQ 16.91 0.56 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS
42 6561D MESAGUT 400MG TAB (ARP) MESALAZINE MESALAZINE MESAGUT 30'S BQ 12.97 0.43 TAB 0 BLIS ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5632 GI PROKINETIC AGENTS 2026-04-01 ORAL 0 GI PROKINETIC AGENTS
40 6561G PENTASA 500MG TAB (FER/STO) MESALAZINE MESALAZINE PENTASA 50'S BQ 89.22 1.78 TABLET 0 TAB FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Package Size Change oral 6 GASTROINTESTINAL DRUGS 2022-03-18
41 6561G PENTASA 500MG TAB (FER) MESALAZINE MESALAZINE PENTASA 50'S BQ 95.49 1.9099 TAB 0 BOX FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2024-04-01 2026-03-31 ORAL 0 GI PROKINETIC AGENTS
42 6561G PENTASA 500MG TAB (FER) MESALAZINE MESALAZINE PENTASA 50'S BQ 107.10 2.14 TAB 0 BLIS FER FERRING PHARMACEUTICALS LTD STO BRYDEN STOKES LTD 5632 GI PROKINETIC AGENTS 2026-04-01 ORAL 0 GI PROKINETIC AGENTS
40 65712 CLOZAPINE 25MG TAB (APL/AHI) CLOZAPINE CLOZAPINE 100'S BP 97.32 0.97 TABLET 270 TAB APL AUROBINDO PHARMA LTD. AHI ARMSTRONG HEALTHCARE INC 28160804 ATYPICAL ANTIPSYCHOTICS 2022-04-01 2022-07-30 Oral 6 CENTRAL NERVOUS SYSTEM DRUGS 2022-03-29