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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 4701F DROPSTAR 0.4% EYE DR (LPO/COL) SOD. HYALURONA SODIUM HYALURONATE DROPSTAR 10ML A 7.61 7.61 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 4701F DROPSTAR 0.4% EYE DR (LPO) SOD. HYALURON (C) SODIUM HYALURONATE DROPSTAR 10ML C 8.37 8.3724 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5292 EENT DRUGS MISCELLANEOPUS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT DRUGS MISCELLANEOPUS