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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 61211 COMBIGAN 0.2% | 0.5% EYE DR (ALL/COL) BRIMONIDINE | TIMOLOL BRIMONIDINE|TIMOLOL COMBIGAN 5ML C 37.11 37.11 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 61211 COMBIGAN 0.2%|0.5% EYE DR (ALL) BRIMONIDINE|TIMOLOL (C) BRIMONIDINE|TIMOLOL COMBIGAN 5ML C 37.11 37.1051 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 61211 COMBIGAN 0.2%|0.5% EYE DR (ALL) BR (C) BRIMONIDINE|TIMOLOL COMBIGAN 5ML C 37.11 37.11 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 6121C BRIMONIDINE | TIMOLOL 0.2% | 0.5% EYE DR (FSB/ATB BRIMONIDINE|TIMOLOL BRIMONIDINE|TIMOLOL 10ML A 8.70 8.70 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 6121C BRIMONIDINE|TIMOLO 0.2%|0.5% EYE DR (FSB BRIMONIDINE|TIMOLOL BRIMONIDINE|TIMOLOL 10ML A 7.56 7.5569 BOTT 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
41 6121F AB PRESS PRESERVATIVE FREE 0.2%|0.5% EYE DR (RLP) BRIMONIDIN BRIMONIDINE|TIMOLOL AB PRESS PRESERVATIVE FREE 10ML A 12.72 12.7218 BOTT 1 BOTT RLP RENOVA LIFESCIENCES PRIVATE LTS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 6121F AB PRESS PF 0.2%|0.5% EYE DR (RLP) BRIMONIDINE|TIMOLOL BRIMONIDINE|TIMOLOL AB PRESS PF 10ML A 13.62 13.62 BOTT 1 BOTT RLP RENOVA LIFESCIENCES PRIVATE LTS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
41 6121G BRIMODIN PLUS 0.2%|0.5% EYE DR (INC) BRIMONIDINE|TIMOLOL BRIMONIDINE|TIMOLOL BRIMODIN PLUS 5ML A 5.38 5.3823 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS