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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 23414 MATROPIN 2% EYE DR (ARP/AHI) HOMATROPINE HOMATROPINE MATROPIN 10ML A 14.11 14.11 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 23415 HOMACID 2% EYE DR (SHC) HOMATROPINE HOMATROPINE HOMACID 5ML A 1.22 1.2232 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5224 EENT MYDRIATICS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT MYDRIATICS
42 23415 HOMACID 2% EYE DR (SHC) HOMATROPINE HOMATROPINE HOMACID 5ML B 2.07 2.07 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5224 EENT MYDRIATICS 2026-04-01 OPHTHALMIC 0 EENT MYDRIATICS