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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 6451L QUIDEX EYE DROP (LPO/COL) CIPRO/DEXAM CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML B 8.15 8.15 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 6451L QUIDEX 0.3%|0.1% EYE DR (LPO) CIPROFLOXACIN|DEXAMETHASONE (BH) CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML BH 8.97 8.9705 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 6451L QUIDEX 0.3%|0.1% EYE DR (LPO) CIPROFLOXACIN|DEXAMETHASONE CIPROFLOXACIN|DEXAMETHASONE QUIDEX 5ML B 16.31 16.31 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 6451Y CIPRODEX 0.3% | 0.1% EAR DR (NVS/COL) CIPROFLOX CIPROFLOXACIN|DEXAMETHASONE CIPRODEX 7.5ML C 29.68 29.68 EAR DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS