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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 01243 OPTOMYCIN 0.5% EYE DR (ASL/PHA) CHLORAMPHENIC CHLORAMPHENICOL OPTOMYCIN 10ML C 4.08 4.08 EYE DROP 0 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
42 0124AE CHLRORAMPHENICOL 0.5% EYE DR (HAN) CHLORAMPHENICOL CHLORAMPHENICOL CHLRORAMPHENICOL 10ML A 1.14 1.14 BOTT 1 HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 0 EENT ANTIBACTERIALS 2026-02-11
42 0124AF CHLORAMPHENICOL 0.5% EYE DR (FSB) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.36 1.36 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 520404 EENT ANTIBACTERIALS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 0 EENT ANTIBACTERIALS 2026-03-05
40 0124N CHLORAMPHENICOL 0.5% EYE DR (MTP/COL) CHLORAMPHENICOL CHLORAMPHENICOL 10ML C 2.58 2.58 EYE DROP 0 BOTT MTP MARTINDALE PHARMACEUTICALS COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 0124R CHLORAMPHENICOL 0.5% EYE DR (CIR/AHI) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.90 1.90 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 0124R CHLORAMPHENICOL 0.5% EYE DR (CIR) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 2.07 2.0659 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
40 0124V CHLORAMPHENICOL 0.5% EYE DR (FSB/ATB) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.60 1.60 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 0124V CHLORAMPHENICOL 0.5% EYE DR (FSB) CHLORAMPHENICOL CHLORAMPHENICOL 10ML A 1.66 1.6582 BOTT 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS
41 0124Y OPTICHLOR 0.5% EYE DR (SHC) CHLORAMPHENICOL CHLORAMPHENICOL OPTICHLOR 10ML A 2.61 2.6096 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2024-04-01 2024-08-01 OPHTHALMIC 0 EENT ANTIBACTERIALS 2024-06-20
40 0125J CHLORAMPHENICOL 1% EYE OINT (MTP/COL) CHLORAMPHENICOL CHLORAMPHENICOL 4G A 4.21 4.21 EYE OINTMENT 1 TUBE MTP MARTINDALE PHARMACEUTICALS COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 0125M OPTICHLOR SL 1% EYE OINTMENT CHLORAMPHENICOL OPTICHLOR SL 1% 5G A $4.35 1 OINT SPC PSB PHARMACEUTICAL SOLUTIONS 520404 EENT ANTIBACTERIALS 2023-06-01 2024-03-31 EYE 0 EENT INFECTIVES 2023-06-09
41 0125M OPTICHLOR SL 1% EYE OINT (SPC) CHLORAMPHENICOL CHLORAMPHENICOL OPTICHLOR SL 5G A 3.26 3.262 TUBE 1 BOX SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIBACTERIALS 2024-06-18
42 0125M OPTICHLOR SL 1% EYE OINT (SPC) CHLORAMPHENICOL CHLORAMPHENICOL OPTICHLOR SL 5G A 3.29 3.29 TUBE 1 BOX SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 OPHTHALMIC 0 EENT ANTIBACTERIALS
40 01261 CHLORAMPHENICOL MINIMS 0.5% EYE DR (CAM/STO) CHLORAMPHENICOL CHLORAMPHENICOL MINIMS 20X0.5ML BQ 94.73 4.74 EYE DROP 0 AMP CAM MORNINGSIDE PHARMACEUTICALS STO BRYDEN STOKES LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 01262 CHLORAMPHENICOL 0.5% EYE/EAR DR (CAM) CHLORAMPHENICOL CHLORAMPHENICOL MINIMS 20X0.5ML A 82.53 4.1264 AMPP 1 BOTT CAM MORNINGSIDE PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 5204 EENT ANTI-INFECTIVES 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI-INFECTIVES
40 0131AE AZITHROMYCIN MK 40MG/ML SUSP (BON/COL) AZITHROMYCIN AZITHROMYCIN MK 15ML A 5.30 0.35 SUSPENSION 30 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AF CLARITHROMYCIN MK 50MG/ML SUSP (BON/COL) CLARITHROMYCIN CLARITHROMYCIN MK 60ML A 14.27 0.24 SUSPENSION 60 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AH CLARITHROMYCIN MK 25MG/ML SUSP (BON/COL) CLARITHROMYCIN CLARITHROMYCIN MK 60ML A 9.38 0.16 SUSPENSION 100 ML BON CORPORACION BONIMA COL COLLINS LTD 08121292 OTHER MACROLIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0131AL ERYTHROMYCIN 50MG/ML SUSP (BON/COL) ERYTHROMY ERYTHROMYCIN ESTOLATE ERYTHROMYCIN 60ML A 7.75 0.13 SUSPENSION 300 ML BON CORPORACION BONIMA COL COLLINS LTD 08121204 ERYTHROMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
42 0131B AZITHRO EZE 40MG/ML SUSP (INF) AZITHROMYCIN AZITHROMYCIN AZITHRO EZE 15ML A 4.59 0.31 ML 30 BOTT INF INFOCUS REMEDIES PVT RXP RX PRO INC 08121292 OTHER MACROLIDES 2026-04-01 ORAL 0 OTHER MACROLIDES