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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 33812 PURILON | GEL (CLP/IMS) ALGINATE | CARBOXYMETHYLCELLULOSE ALGINATE|CARBOXYMETHYLCELLULOSE PURILON 10X25G B 133.50 13.35 GEL 0 TUBE CLP COLOPLAST A/S IMS ISLANDS MEDICAL SUPPLIES INC 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 47014 REFRESH LIQUIGEL 1% EYE DR (ALL/COL) HYPROMEL CARBOXYMETHYLCELLULOSE REFRESH LIQUIGEL 15ML A 11.55 11.55 EYE DROP 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 47014 REFRESH LIQUIGEL 1% EYE DR (ALL) HYPROME (B) CARBOXYMETHYLCELLULOSE REFRESH LIQUIGEL 15ML B 11.55 11.5529 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 47014 REFRESH LIQUIGEL 1% EYE DR (ALL) HYPROME CARBOXYMETHYLCELLULOSE REFRESH LIQUIGEL 15ML B 11.55 11.55 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
40 4701AV REFRESH OPTIVE GEL 1% | 0.9% EYE DR (ALL/COL) CARBOXYMETHYLCELLULOSE | GLYCERINE CARBOXYMETHYLCELLULOSE|GLYCERINE REFRESH OPTIVE GEL 10ML C 12.91 12.91 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4701AV REFRESH OPTIVE GEL 1%|0.9% EYE DR (ALL) CARBOXYMETHYLCELLULO (C) CARBOXYMETHYLCELLULOSE|GLYCERINE REFRESH OPTIVE GEL 10ML C 12.91 12.912 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
42 4701AV REFRESH OPTIVE GEL 1%|0.9% EYE DR (ALL) CARBOXYMETHYLCELLULO CARBOXYMETHYLCELLULOSE|GLYCERINE REFRESH OPTIVE GEL 10ML C 12.91 12.91 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
40 4701AY DRYLIEF 1% EYE DR (ARP/AHI) CARBOXYMETHYLCELL CARBOXYMETHYLCELLULOSE DRYLIEF 10ML A 6.93 6.93 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4701AY DRYLIEF 1% EYE DR (ARP) CARBOXYMETH CARBOXYMETHYLCELLULOSE DRYLIEF 10ML A 6.82 6.823 BOTT 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
41 4701B REFRESH TEARS 0.5% EYE DR (ALL) CARBOXYMETHYLCELLULOSE (C) CARBOXYMETHYLCELLULOSE REFRESH TEARS 15ML C 11.55 11.5529 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
42 4701B REFRESH TEARS 0.5% EYE DR (ALL) CARBOXYMETHYLCELLULOSE CARBOXYMETHYLCELLULOSE REFRESH TEARS 15ML C 11.55 11.55 BOTT 1 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
41 4701BA AUCIC 1% EYE DR (LPO) CARBOXYMETHYLCELLULOSE CARBOXYMETHYLCELLULOSE AUCIC 10ML A 8.26 8.2637 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 4701BE I-DEW SOOTHE 0.5% EYE DR (DCI) CARBOXYMETHYLCELLULOSE CARBOXYMETHYLCELLULOSE I-DEW SOOTHE 15ML A 6.42 6.42 BOTT 1 BOTT DCI DCI PHARMACEUTICALS PVT LTD PSB PHARMACEUTICAL SOLUTIONS BARBA 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 4701BG LOC TEARS FUSION 1% EYE DR (ADO) CARBOXYMETHYLCELLULOSE CARBOXYMETHYLCELLULOSE LOC TEARS FUSION 15ML A 5.16 5.16 BOTT 1 BOTT ADO ADORE PHARMA PSB PHARMACEUTICAL SOLUTIONS BARBA 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 4701BR CARBOXYMETHYLCELLULOSE 0.5% EYE DR (CHC) CARBOXYMETHYLCELLULOSE CARBOXYMETHYLCELLULOSE 15ML A 2.75 2.75 BOTT 1 CHC CARITAS HEALTHCARE PVT LTD STO BRYDEN STOKES LTD 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS 2026-03-05
40 4701K OPTIVE .05%C/0.9%G EYE DR (ALL/COL) CARBOXY/G CARBOXYMETHYLCELLULOSE|GLYCERINE OPTIVE 15ML C 13.59 13.59 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4701K OPTIVE 0.5%|0.9% EYE DR (ALL) CARBOXYMETHYLCELLULOSE|GLYCERI (C) CARBOXYMETHYLCELLULOSE|GLYCERINE OPTIVE 15ML C 13.59 13.5916 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS