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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 6451R GATIDEX 0.1% | 0.3% EYE DR (LPO/COL) DEXAMETHASONE | GATIFLOXACIN DEXAMETHASONE|GATIFLOXACIN GATIDEX 5ML BQ 9.51 9.51 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