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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 A531AW BIMATOPROST 0.01% EYE DR (CIR) BIMATOPROST BIMATOPROST 2.5ML A 9.24 9.24 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524028 EENT PROSTAGLANDIN ANALOGS 2024-07-23 2025-01-16 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS 2024-07-23
41 A531AW BIMATOPROST 0.01% EYE DR (CIR) BIMATOPROST BIMATOPROST 2.5ML A 12.83 12.83 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524028 EENT PROSTAGLANDIN ANALOGS 2025-01-17 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS 2025-01-17
42 A531BH BITOD LS 0.01% EYE DR (SYP) BIMATOPROST BIMATOPROST BITOD LS 3ML A 8.54 8.54 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
40 A531J LUMIGAN 0.01% EYE DR (ALL/COL) BIMATOPROST BIMATOPROST LUMIGAN 2.5ML C 41.32 41.32 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A531J LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST (C) BIMATOPROST LUMIGAN 2.5ML C 41.32 41.3185 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A531J LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST BIMATOPROST LUMIGAN 2.5ML C 41.32 41.32 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS