Displaying 1 - 3 of 3
  • Print
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 41458 ACULAR LS 0.4% EYE DR (ALL/COL) KETOROLAC KETOROLAC ACULAR LS 5ML C 26.64 26.64 EYE DROP 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 520820 EENT NSAID 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 41458 ACULAR LS 0.4% EYE DR (ALL) KETOROLAC (C) KETOROLAC ACULAR LS 5ML C 26.64 26.6396 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL COLLINS LTD 5208 EENT ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS
42 41458 ACULAR LS 0.4% EYE DR (ALL) KETOROLAC KETOROLAC ACULAR LS 5ML C 26.64 26.64 BOTT 0 BOTT ALL ALLERGAN INTERNATIONAL COL AVENTA BARBADOS 5208 EENT ANTI-INFLAMMATORY AGENTS 2026-04-01 OPHTHALMIC 0 EENT ANTI-INFLAMMATORY AGENTS