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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 | 6451AA | MAXITROL 1MG/ML | 3MG/ML | 10,000U EYE DR (NVS/COL) DEXAMETHASONE | NEOMYCIN | P More ... | DEXAMETHASONE|NEOMYCIN|POLYMYXIN B | MAXITROL | 5ML | BQ | 32.08 | 32.08 | EYE DROP | 0 | BOTT | NVS | NOVARTIS CARIBE SA | COL | COLLINS LTD | 5206 | ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 6 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 6451M | MAXISPORIN 1MG/ML | 3MG EYE DR (ASL/PHA) DEXAMETHASONE | NEOMYCIN | POLYMYXIN B | DEXAMETHASONE|NEOMYCIN|POLYMYXIN B | MAXISPORIN | 5ML | BQ | 5.52 | 5.52 | EYE DROP | 0 | BOTT | ASL | ASHFORD LABORATORIES LTD | PHA | PHARMACY SALES CARIBBEAN | 5206 | ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 6 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||