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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 40517 POENCANIA 0.5% EYE DR (LPO/COL) PROPARACAINE PROPARACAINE POENCANIA 10ML A 8.43 8.43 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5216 EENT LOCAL ANESTHETIC 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE PROPARACAINE P-CAINE 5ML A 3.13 3.1261 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5216 EENT LOCAL ANESTHETIC 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT LOCAL ANESTHETIC
42 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE PROPARACAINE P-CAINE 5ML A 3.26 3.26 BOTT 1 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 5216 EENT LOCAL ANESTHETIC 2026-04-01 OPHTHALMIC 6 EENT LOCAL ANESTHETIC