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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 62614 N-MYCIN 5% EYE DR (ARP/AHI) NATAMYCIN NATAMYCIN N-MYCIN 5ML BQ 20.99 20.99 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520416 EENT ANTIFUNGALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 62615 NATACIN 5% EYE DR (AKU) NATAMYCIN NATAMYCIN NATACIN 5ML BQ 5.52 5.5182 BOTT 0 BOTT AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 520416 EENT ANTIFUNGALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIFUNGALS
42 62615 NATACIN 5% EYE DR (AKU) NATAMYCIN NATAMYCIN NATACIN 5ML BQ 5.44 5.44 BOTT 0 VIAL AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 520416 EENT ANTIFUNGALS 2026-04-01 OPHTHALMIC 0 EENT ANTIFUNGALS