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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 64212 NEORAL 100MG/ML SOLN (NVS/COL) CYCLOSPORIN CYCLOSPORIN NEORAL 50ML BQ 475.71 475.71 SOLUTION 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 0 ANTINEOPLASTICS
41 64212 NEORAL 100MG/ML SOLN (NVS) CYCLOSPORIN CYCLOSPORIN NEORAL 50ML BQ 475.71 475.7067 BOTT 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 0 IMMUNOSUPPRESSIVE AGENTS
40 64225 NEORAL 25MG TAB (NVS/COL) CYCLOSPORIN CYCLOSPORIN NEORAL 50'S BQ 135.18 2.70 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
41 64225 NEORAL 25MG TAB (NVS) CYCLOSPORIN (BQ) CYCLOSPORIN NEORAL 50'S BQ 135.18 2.7036 TAB 0 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 0 IMMUNOSUPPRESSIVE AGENTS
40 6422B NEORAL 100MG TAB (NVS/COL) CYCLOSPORIN CYCLOSPORIN NEORAL 50'S BQ 529.88 10.60 TABLET 0 TAB NVS NOVARTIS CARIBE SA COL COLLINS LTD 1000 ANTINEOPLASTICS 2022-04-01 2024-03-31 Oral 6 ANTINEOPLASTICS
41 6422B NEORAL 100MG TAB (NVS) CYCLOSPORIN (BQ) CYCLOSPORIN NEORAL 50'S BQ 529.88 10.5977 TAB 0 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 ORAL 0 IMMUNOSUPPRESSIVE AGENTS
40 64231 RESTASIS 0.05% EYE (ALL/COL) CYCLOSPORIN CYCLOSPORIN RESTASIS 30X0.4ML C 67.96 2.27 EYE DROP 0 AMP ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 520892 EENT ANTI INFLAMMATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 64231 RESTASIS 0.05% EYE DR (ALL) CYCLOSP (C) CYCLOSPORIN RESTASIS 30X0.4ML C 67.96 2.2653 AMPP 0 BOX ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 520892 EENT ANTI INFLAMMATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI INFLAMMATORY AGENTS MISCELLANEOUS
41 64235 CLOSPORIL 0.1% EYE DR (LPO) CYCLOSPORIN (C) CYCLOSPORIN CLOSPORIL 5ML C 10.06 10.0578 BOTT 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 520892 EENT ANTI INFLAMMATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI INFLAMMATORY AGENTS MISCELLANEOUS