Displaying 1 - 12 of 12
| 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 | 4701AR | SYSTANE 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE | 15ML | C | 17.75 | 17.75 | 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 | 4701AR | SYSTANE 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400|PROPY (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE | 15ML | C | 20.25 | 20.2515 | 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 | 4701AR | SYSTANE 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400|PROPY | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE | 15ML | C | 18.89 | 18.89 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | A | 5292 | EENT DRUGS MISCELLANEOPUS | 2026-04-01 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AS | SYSTANE GEL DROPS 0.4% | 0.3% EYE DR (ALC/AHI) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE GEL DROPS | 10ML | C | 16.26 | 16.26 | 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 | 4701AS | SYSTANE GEL DROPS 0.4%|0.3% EYE DR (ALC) (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE GEL DROPS | 10ML | C | 18.54 | 18.539 | 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 | 4701AS | SYSTANE GEL DROPS 0.4%|0.3% EYE DR | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE GEL DROPS | 10ML | C | 17.67 | 17.67 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | A | 5292 | EENT DRUGS MISCELLANEOPUS | 2026-04-01 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AT | SYSTANE ULTRA 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE G More ... | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE ULTRA | 10ML | C | 12.64 | 12.64 | 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 | 4701AT | SYSTANE ULTRA 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400 (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE ULTRA | 10ML | C | 15.33 | 15.3313 | 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 | 4701AT | SYSTANE ULTRA 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400 | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE ULTRA | 10ML | C | 15.33 | 15.33 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | A | 5292 | EENT DRUGS MISCELLANEOPUS | 2026-04-01 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AX | SYSTEAR 0.4% | 0.3% EYE DR (ARP/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTEAR | 10ML | A | 7.34 | 7.34 | EYE DROP | 1 | BOTT | ARP | ARISTOPHARMA LTD | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 6 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AX | SYSTEAR 0.4%|0.3% EYE DR (ARP) POLYETHYLENE GLYCOL 400|PROPY | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTEAR | 10ML | A | 7.42 | 7.421 | BOTT | 1 | BOTT | ARP | ARISTOPHARMA LTD | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 42 | 4701AX | SYSTEAR 0.4%|0.3% EYE DR (ARP) POLYETHYLENE GLYCOL 400|PROPY | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTEAR | 10ML | A | 8.10 | 8.10 | BOTT | 1 | BOTT | ARP | ARISTOPHARMA LTD | AHI | ARMSTRONG HEALTHCARE INC | A | 5292 | EENT DRUGS MISCELLANEOPUS | 2026-04-01 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||