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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 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2022-12-31 Delete from contract OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-12-31
40 12012 GLAUCOTENSIL TD 2% | 0.5% EYE DR (LPO/COL) DORZ DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 12.23 12.23 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 13.46 13.4557 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML B 19.03 19.03 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE DORZOLAMIDE|TIMOLOL DORZOL-T 10ML A 21.61 21.61 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 1201S ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 11.69 11.6888 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 1201T ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 12.48 12.48 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP 0 MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2022-12-31 Del OPHTHALMIC 0 EENT CARBONIC ANHYDRASE INHIBITORS 2022-12-31
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) DORZOLAMIDE TRUSOPT 5ML C 28.54 28.54 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-04 2022-12-31 Delete from contract OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS 2022-12-31
40 A3714 GLAUCOTENSIL D 2% EYE DR (LPO/COL) DORZOLAMID DORZOLAMIDE GLAUCOTENSIL D 5ML A 14.95 14.95 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A3714 GLAUCOTENSIL D 2% EYE DR (LPO) DORZOLAMI (C) DORZOLAMIDE GLAUCOTENSIL D 5ML C 16.45 16.4459 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
42 A3714 GLAUCOTENSIL D 2% EYE DR (LPO) DORZOLAMI DORZOLAMIDE GLAUCOTENSIL D 5ML B 20.39 20.39 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2026-04-01 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
40 A371H DORZOL 2% EYE DR (CIR/AHI) DORZOLAMIDE DORZOL 5ML A 12.12 12.12 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A371H DORZOL 2% EYE DR (CIR) DORZOLAMIDE DORZOL 5ML A 13.73 13.7275 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
41 A371T ENDOR 2% EYE DR (SYP) DORZOLAMIDE DORZOLAMIDE ENDOR 5ML A 12.69 12.6946 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
42 A371T ENDOR 2% EYE DR (SYP) DORZOLAMIDE DORZOLAMIDE ENDOR 5ML A 10.95 10.95 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2026-04-01 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS
41 A371W DORZOL 2% EYE DR (CIR) DORZOLAMIDE DORZOL 10ML A 21.75 21.75 BOTT 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524012 EENT CARBONIC ANHYDRASE INHIBITORS 2025-01-10 2026-03-31 OPHTHALMIC 6 EENT CARBONIC ANHYDRASE INHIBITORS 2025-01-10