Displaying 1 - 11 of 11
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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 2411B HYPROMELLOSE 0.3% EYE DR (ASL/PHA) HYPROMELLOSE HYPROMELLOSE 10ML A 3.75 3.75 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2411B HYPROMELLOSE 0.3% EYE DR (ASL) HYPROMELLOSE HYPROMELLOSE 10ML A 7.64 7.6385 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 2411J LACRYL SOOTHE 0.3% EYE DR (ABL) HYPROMELLOSE HYPROMELLOSE LACRYL SOOTHE 10ML A 3.94 3.94 BOTT 1 BOTT ABL ABLE PHARMA PSB PHARMACEUTICAL SOLUTIONS BARBA 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
40 33811 INTRASITE GEL GEL (SMN/IMS) HYPROMELLOSE | PROPYLENE GLYCOL HYPROMELLOSE|PROPYLENE GLYCOL INTRASITE GEL 10X25G B 133.50 13.35 GEL 0 TUBE SMN SMITH & NEPHEW PHARMACEUTICALS IMS ISLANDS MEDICAL SUPPLIES INC 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 33811 INTRASITE GEL GEL (SMN) HYPROMELLOSE|PROPYLENE GLYCOL HYPROMELLOSE|PROPYLENE GLYCOL INTRASITE GEL 10X25G B 139.99 13.9994 TUBE 0 BOX SMN SMITH & NEPHEW PHARMACEUTICALS IMS ISLANDS MEDICAL SUPPLIES INC 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2024-04-01 2026-03-31 TOPICAL 0 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
40 4701AP TEARS NATURALE FORTE EYE DR (ALC/AHI) DEXTRAN | GLYCERINE | HYPROMELLOSE DEXTRAN|GLYCERINE|HYPROMELLOSE TEARS NATURALE FORTE 15ML C 13.32 13.32 EYE DROP 0 BOTT ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 Ophthalmic 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4701AQ TEARS NATURALE II 0.1% | 0.3% EYE DR (ALC/AHI) DEXTRAN | HYPROMELLOSE DEXTRAN 70|HYPROMELLOSE TEARS NATURALE II 15ML C 12.67 12.67 EYE DROP 0 BOTT ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 Ophthalmic 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4701AQ TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN|HYPROMELLOS (C) DEXTRAN 70|HYPROMELLOSE TEARS NATURALE II 15ML C 17.89 17.8866 BOTT 1 BOTT ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 4701AQ TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN 70|HYPROMEL DEXTRAN 70|HYPROMELLOSE TEARS NATURALE II 15ML C 16.31 16.31 BOTT 0 BOTT ALC ALCON LABORATORIES INC. AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OPHTHALMIC 0 EENT DRUGS MISCELLANEOPUS
40 4701AZ DEXTRAN | HYPROMELLOSE 0.1% | 0.3% EYE DR (FSB/AT DEXTRAN|HYPROMELLOSE DEXTRAN|HYPROMELLOSE 15ML A 5.41 5.41 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4701B REFRESH TEARS 0.5% EYE DR (ALL/COL) HYPROMELL HYPROMELLOSE REFRESH TEARS 15ML C 11.55 11.55 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS