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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 23132 MIOSTAT OCULAR 0.01% INJ (ALC/AHI) CARBACHOL CARBACHOL MIOSTAT OCULAR 1.5ML VIAL BQ 59.94 59.94 INJECTION 0 VIAL ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 524020 EENT MIOTICS 2022-04-01 2024-03-31 IV 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 23132 MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL CARBACHOL MIOSTAT OCULAR 1.5ML VIAL BQ 55.18 55.182 VIAL 0 VIAL ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 524020 EENT MIOTICS 2024-04-01 2026-03-31 IV 0 EENT MIOTICS
42 23132 MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL CARBACHOL MIOSTAT OCULAR 1.5ML VIAL BQ 52.95 52.95 VIAL 0 VIAL ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 524020 EENT MIOTICS 2026-04-01 IV 0 EENT MIOTICS