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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
42 4061H ANTAZOLINE|NAPHAZOLINE 0.5%|0.05% EYE DR (FSB) ANTAZOLINE|NAPHAZOLINE ANTAZOLINE|NAPHAZOLINE 10ML A 6.14 6.14 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 5232 EENT VASOCONSTRICTORS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 6 EENT VASOCONSTRICTORS 2026-03-05