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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 A3612 ARCALION 200MG TAB (SER) SULBUTIAMI (C) SULBUTIAMINE ARCALION 20'S C 24.46 1.2232 TAB 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2024-04-01 2026-03-31 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
42 A3612 ARCALION 200MG TAB (SER) SULBUTIAMI SULBUTIAMINE ARCALION 20'S C 24.46 1.22 TAB 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2026-04-01 2028-03-31 ORAL 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 A3613 SULBUTIAMINE 200MG TAB (KWA/ATB) SULBUTIAMINE SULBUTIAMINE 20'S C 12.23 0.61 TABLET 0 TAB KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 9200 UNCLASSIFIED THERAPEUTIC AGENTS 2022-04-01 2024-03-31 Oral 0 UNCLASSIFIED THERAPEUTIC AGENTS
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP 0 MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2022-12-31 Del OPHTHALMIC 0 EENT CARBONIC ANHYDRASE INHIBITORS 2022-12-31
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-04 2022-12-31 Delete from contract OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS 2022-12-31
40 A3714 GLAUCOTENSIL D 2% EYE DR (LPO/COL) DORZOLAMID DORZOLAMIDE GLAUCOTENSIL D 5ML A 14.95 14.95 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A3714 GLAUCOTENSIL D 2% EYE DR (LPO) DORZOLAMI (C) DORZOLAMIDE GLAUCOTENSIL D 5ML C 16.45 16.4459 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
42 A3714 GLAUCOTENSIL D 2% EYE DR (LPO) DORZOLAMI DORZOLAMIDE GLAUCOTENSIL D 5ML B 20.39 20.39 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
40 A371E BRIZOTEN 1% EYE DR (LPO/COL) BRINZOLAMIDE BRINZOLAMIDE BRIZOTEN 5ML A 19.03 19.03 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
42 A371E BRIZOTEN 1% EYE DR (LPO) BRINZOLAMIDE BRINZOLAMIDE BRIZOTEN 5ML C 24.46 24.46 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
40 A371H DORZOL 2% EYE DR (CIR/AHI) DORZOLAMIDE DORZOL 5ML A 12.12 12.12 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A371H DORZOL 2% EYE DR (CIR) DORZOLAMIDE DORZOL 5ML A 13.73 13.7275 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
41 A371R AZOPT 1% EYE DR (NVS) BRINZOLAMIDE BRINZOLAMIDE AZOPT 10ML A 29.22 29.222 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2024-06-17 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS 2024-05-06
41 A371T ENDOR 2% EYE DR (SYP) DORZOLAMIDE DORZOLAMIDE ENDOR 5ML A 12.69 12.6946 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
42 A371T ENDOR 2% EYE DR (SYP) DORZOLAMIDE DORZOLAMIDE ENDOR 5ML A 10.95 10.95 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
41 A371V AZOPT 1% DROPS (NVS) BRINZOLAMIDE BRINZOLAMIDE AZOPT 5ML BOTT A 14.61 14.61 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 402804 CARBONIC ANHYDRASE INHIBITORS 2024-05-06 2026-03-31 OPHTHALMIC 6 CARBONIC ANHYDRASE INHIBITORS 2024-05-06
42 A371V AZOPT 1% EYE DR (NVS) BRINZOLAMIDE BRINZOLAMIDE AZOPT 5ML A 14.62 14.62 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS B 402804 CARBONIC ANHYDRASE INHIBITORS 2026-04-01 2028-03-31 OPHTHALMIC 6 CARBONIC ANHYDRASE INHIBITORS
41 A371W DORZOL 2% EYE DR (CIR) DORZOLAMIDE DORZOL 10ML A 21.75 21.75 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2025-01-10 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS 2025-01-10
40 A3911 SERETIDE DISKUS 250MCG | 50MCG INHR (GSK/COL) F FLUTICASONE|SALMETEROL SERETIDE DISKUS 60 DOSES C 55.45 55.45 INHALER 0 INHR GSK GLAXOSMITHKLINE COL COLLINS LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 0 RESPIRATORY TRACT AGENTS