Displaying 1 - 17 of 17
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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
41 77013 GOTABIOTIC F 0.1%|0.3% EYE DR (LPO) DEXAMETHASONE|TOBRAMYCIN (C) DEXAMETHASONE|TOBRAMYCIN GOTABIOTIC F 5ML C 7.58 7.5841 BOTT 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 ORAL 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 7701D DEXAMETHASONE/TOBRAMYCIN EYE DR (CIR/AHI) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.16 5.16 EYE DROP 0 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 7701D DEXAMETHASONE|TOBRAMYCIN 0.1%|0.3% EYE DR (CIR) (BQ) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.16 5.1648 BOTT 0 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 7701E DEXAMETHASONE/TOBRAMYCIN EYE DR (KWA/ATB) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.41 5.41 EYE DROP 0 BOTT KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 7701H TOBRADEX 0.1% | 0.3% EYE DR (NVS/COL) DEXAMETHA DEXAMETHASONE|TOBRAMYCIN TOBRADEX 5ML C 21.09 21.09 EYE 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
41 7701H TOBRADEX 0.1%|0.3% EYE DR (NVS) DEXAMETHASONE|TOBRAMYCIN (C) DEXAMETHASONE|TOBRAMYCIN TOBRADEX 5ML C 23.79 23.7853 BOTT 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 7701H TOBRADEX 0.1%|0.3% EYE DR (NVS) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN TOBRADEX 5ML C 23.79 23.79 BOTT 0 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
41 7701J TOBAGRAM D 0.1%|0.3% EYE DR (HAN) DEXAMETHASONE|TOBRAMYCIN (BQ) DEXAMETHASONE|TOBRAMYCIN TOBAGRAM D 10ML BQ 4.27 4.2678 BOTT 0 BOTT HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 7701J TOBAGRAM D 0.1%|0.3% EYE DR (HAN) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN TOBAGRAM D 10ML BQ 4.30 4.29 BOTT 0 BOTT HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 77022 GOTABIOTIC F EYE OINT (LPO/COL) DEXAMETHASON DEXAMETHASONE|TOBRAMYCIN GOTABIOTIC F 3.5G C 11.69 11.69 EYE OINTMENT 0 TUBE LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 77022 GOTABIOTIC F EYE OINT (LPO) DEXAMETHASO (C) DEXAMETHASONE|TOBRAMYCIN GOTABIOTIC F 3.5G C 12.86 12.8577 TUBE 0 BOX LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 77025 T-MYCIN PLUS EYE OINT (ARP/AHI) DEXAMETHASON DEXAMETHASONE|TOBRAMYCIN T-MYCIN PLUS 3.5G BQ 7.12 7.12 EYE OINTMENT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 77027 TOBRADEX 0.1% | 0.3% EYE OINT (NVS/COL) DEXAMET DEXAMETHASONE|TOBRAMYCIN TOBRADEX 3.5G C 23.73 23.73 EYE OINTMENT 0 TUBE 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
41 77027 TOBRADEX 0.1%|0.3% EYE OINT (NVS) D (C) DEXAMETHASONE|TOBRAMYCIN TOBRADEX 3.5G C 23.73 23.731 TUBE 1 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 77027 TOBRADEX 0.1%|0.3% EYE OINT (NVS) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN TOBRADEX 3.5G C 23.73 23.73 TUBE 1 BOX NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
41 77028 TOBAGRAM D 0.1%|0.3% EYE DR (SPC) DEXAMETHASONE|TOBRAMYCIN (BQ) DEXAMETHASONE|TOBRAMYCIN TOBAGRAM D 5G BQ 4.27 4.2678 TUBE 1 TUBE SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
42 77028 TOBAGRAM D 0.1%|0.3% EYE OINT (SPC) DEXAMETHASONE|TOBRAMYCI DEXAMETHASONE|TOBRAMYCIN TOBAGRAM D 5G B 4.40 4.40 TUBE 1 TUBE SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 6 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS