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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 1184K BISOPROLOL 10MG TAB (RYV/ATB) BISOPROLOL BISOPROLOL 100'S A 8.57 0.09 TABLET 30 TAB RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-07-20 2024-03-31 Price Change Oral 6 CARDIOVASCULAR DRUGS 2022-07-19
41 1184K BISOPROLOL 10MG TAB (RYV) BISOPROLOL BISOPROLOL 100'S A 10.87 0.1087 TAB 30 BOX RYV RYVIS PHARMA PVT. LTD ATB ANSA TRADING BARBADOS LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2024-04-01 2026-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 1184M CILENOL 10MG TAB (CIR/AHI) BISOPROLOL BISOPROLOL CILENOL 3X10 A 5.06 0.17 TABLET 30 TAB CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 2424 BETA ADRENERGIC BLOCKING AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 1184M CILENOL 10MG TAB (CIR) BISOPROLOL BISOPROLOL CILENOL 10MG TAB 30'S A $4.05 $0.135 TABLET 30 TABS CIR CIRON, PHARMA AHI ARMSTRONG HEALTHCARE INC B 2424 2023-06-06 2024-03-31 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS 2023-06-09
42 1184X BISOSTAL 10MG TAB (STL) BISOPROLOL BISOPROLOL BISOSTAL 10X10 A 2.94 0.03 TAB 30 BLIS STL STALLION LABORATORIES SBI MASSY DISTRIBUTION (BDOS) LTD B 2424 BETA ADRENERGIC BLOCKING AGENTS 2026-04-01 ORAL 6 BETA ADRENERGIC BLOCKING AGENTS
40 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2022-12-31 Delete from contract OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-12-31
40 12012 GLAUCOTENSIL TD 2% | 0.5% EYE DR (LPO/COL) DORZ DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 12.23 12.23 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 13.46 13.4557 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML B 19.03 19.03 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 1201P AZARGA 1% | 0.5% EYE DR (NVS/COL) BRINZOLAMIDE | BRINZOLAMIDE|TIMOLOL AZARGA 5ML C 19.79 19.79 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL (BQ) BRINZOLAMIDE|TIMOLOL AZARGA 5ML BQ 19.79 19.7894 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL BRINZOLAMIDE|TIMOLOL AZARGA 5ML BQ 19.79 19.79 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 0 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE DORZOLAMIDE|TIMOLOL DORZOL-T 10ML A 21.61 21.61 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 1201S ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 11.69 11.6888 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 1201T ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 12.48 12.48 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 12116 ANGIRON 0.5MG SL TAB (CIR/AHI) GLYCERYL TRINI GLYCERYL TRINITRATE ANGIRON 30'S A 11.53 11.53 TABLET 30 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 12118 GLYCERYL TRINITRATE 0.6MG TAB (KWA) GLYCERYL TRINITRATE GLYCERYL TRINITRATE 100'S A 18.0225 0.1802 TAB 30 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 2412 VASODILATING AGENTS 2024-04-01 2026-03-31 ORAL 6 VASODILATING AGENTS
40 12121 MINITRAN 5MG PATCH (PMA/AHI) GLYCERYL TRINITR GLYCERYL TRINITRATE MINITRAN 30'S BQ 46.21 46.21 PATCH 0 PACK PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 TOPICAL 6 CARDIOVASCULAR DRUGS
41 12121 MINITRAN 5MG PATCH (PMA) GLYCERYL TRINIT (BQ) GLYCERYL TRINITRATE MINITRAN 30'S BQ 54.37 54.3665 PACK 6 BOX PMA MORE PHARMA CORPORATION AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2024-04-01 2026-03-31 TOPICAL 0 NITRATES AND NITRITES