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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 40613 ALLEREX 0.05% | 0.04% EYE DR (ASL/PHA) ANTAZOLI ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 5.79 5.79 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOL ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 8.81 8.8074 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT VASOCONSTRICTORS
42 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOLINE|TETRAHYDROZOLINE ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A 8.13 8.13 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2026-04-01 OPHTHALMIC 6 EENT VASOCONSTRICTORS