Displaying 1 - 20 of 20
| 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 | 33811 | INTRASITE GEL GEL (SMN/IMS) HYPROMELLOSE | PROPYLENE GLYCOL | HYPROMELLOSE|PROPYLENE GLYCOL | INTRASITE GEL | 10X25G | B | 133.50 | 13.35 | GEL | 0 | TUBE | SMN | SMITH & NEPHEW PHARMACEUTICALS | IMS | ISLANDS MEDICAL SUPPLIES INC | 8436 | MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS | 2022-04-01 | 2024-03-31 | TOPICAL | 0 | SKIN-MUCOUS MEMBRANE PREPARATIONS | |||||
| 41 | 33811 | INTRASITE GEL GEL (SMN) HYPROMELLOSE|PROPYLENE GLYCOL | HYPROMELLOSE|PROPYLENE GLYCOL | INTRASITE GEL | 10X25G | B | 139.99 | 13.9994 | TUBE | 0 | BOX | SMN | SMITH & NEPHEW PHARMACEUTICALS | IMS | ISLANDS MEDICAL SUPPLIES INC | 8436 | MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS | 2024-04-01 | 2026-03-31 | TOPICAL | 0 | MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS | |||||
| 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 | 4701AU | SYSTANE BALANCE 0.6% EYE DR (ALC/AHI) PROPYLE | PROPYLENE GLYCOL | SYSTANE BALANCE | 10ML | C | 19.03 | 19.03 | 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 | 4701AU | SYSTANE BALANCE 0.6% EYE DR (ALC) PROPYL (C) | PROPYLENE GLYCOL | SYSTANE BALANCE | 10ML | C | 21.69 | 21.6922 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 0 | EENT DRUGS MISCELLANEOPUS | |||||
| 42 | 4701AU | SYSTANE BALANCE 0.6% EYE DR (ALC) P | PROPYLENE GLYCOL | SYSTANE BALANCE | 10ML | C | 20.63 | 20.63 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2026-04-01 | 2028-03-31 | OPHTHALMIC | 0 | 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 | |||||
| 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 | |||||
| 40 | 5591A | CERUMOL EAR DR (THR/SBI) PROPYLENE GLYCOL | TU | PROPYLENE GLYCOL|TURPENTINE OIL | CERUMOL | 11ML | A | 4.35 | 4.35 | EAR DROP | 1 | BOTT | THR | THORNTON & ROSS LTD | SBI | MASSY DISTRIBUTION (BDOS) LTD | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OTIC | 6 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||