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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
41 4701BB FILTEAR 0.4%|0.3% EYE DR (INC) POLYETHYLENE GLYCOL|PROPYLENE POLYETHYLENE GLYCOL|PROPYLENE GLYCOL FILTEAR 10ML A 8.18 8.1822 BOTT 1 BOTT INC INCEPTA PHARMACEUTICALS LIMITED AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS
42 4701BS POLYETHYLENE GLYCOL|PROPYLENE GLYCOL 0.4%|0.3% EYE DR (CHC) POLYETHYLENE GLYCOL|PROPYLENE GLYCOL POLYETHYLENE GLYCOL|PROPYLENE GLYCO 15ML A 1.25 1.25 BOTT 1 CHC CARITAS HEALTHCARE PVT LTD STO BRYDEN STOKES LTD 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS 2026-03-05