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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 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP 0 BOTT MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) DORZOLAMIDE|TIMOLOL COSOPT 5ML C 24.76 24.76 EYE DROP MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2022-12-31 Delete from contract OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-12-31
40 12012 GLAUCOTENSIL TD 2% | 0.5% EYE DR (LPO/COL) DORZ DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 12.23 12.23 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML A 13.46 13.4557 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL GLAUCOTENSIL TD 5ML B 19.03 19.03 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 1201P AZARGA 1% | 0.5% EYE DR (NVS/COL) BRINZOLAMIDE | BRINZOLAMIDE|TIMOLOL AZARGA 5ML C 19.79 19.79 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL (BQ) BRINZOLAMIDE|TIMOLOL AZARGA 5ML BQ 19.79 19.7894 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL BRINZOLAMIDE|TIMOLOL AZARGA 5ML BQ 19.79 19.79 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 0 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE DORZOLAMIDE|TIMOLOL DORZOL-T 10ML A 21.61 21.61 EYE DROP 1 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 1201S ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 11.69 11.6888 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 1201T ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL DORZOLAMIDE|TIMOLOL ENDOR PLUS 5ML A 12.48 12.48 BOTT 1 BOTT SYP SYAASH PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 40712 TIMOLOL EX 0.25% EYE DR (FSB/ATB) TIMOLOL EX TIMOLOL EX 5ML A 1.09 1.09 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Price Change Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2021-12-08
42 40713 OPTIMOL 0.25% EYE DR (ASL) TIMOLOL TIMOLOL OPTIMOL 5ML A 8.16 8.15 BOTT 2 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 524008 EENT BETA ADRENERGIC AGENTS 2026-04-01 2028-03-31 OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS
40 4073X POENTIMOL 0.5% EYE DR (LPO/COL) TIMOLOL TIMOLOL POENTIMOL 5ML C 5.44 5.44 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Add to Contract as Cat C OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-04-01
40 4074AG TIMOLOL 0.25% EYE DR (FSB/ATB) TIMOLOL TIMOLOL 10ML A 1.60 1.60 EYE DROP 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2022-04-01 2024-03-31 Price Change Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS 2021-12-08
41 4074AG TIMOLOL 0.25% EYE DR (FSB) TIMOLOL TIMOLOL 10ML A 1.66 1.6582 BOTT 1 BOTT FSB FLAGSHIP BIOTECH ATB ANSA TRADING BARBADOS LTD B 524008 EENT BETA ADRENERGIC AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS
42 4074AH TIMOLOL 0.25% EYE DR (FSB) TIMOLOL TIMOLOL 10ML A 1.36 1.36 BOTT 1 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD B 524008 EENT BETA ADRENERGIC AGENTS 2026-04-01 Add to Contract as Cat A OPHTHALMIC 6 EENT BETA ADRENERGIC AGENTS 2026-03-05
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP LATANOPROST|TIMOLOL XALACOM 2.5ML C 28.68 28.68 EYE DROP 0 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP LATANOPROST|TIMOLOL XALACOM 2.5ML C 37.89 37.89 EYE DROP 0 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2022-07-27 2024-03-31 Price Change OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-07-26
41 51311 XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL (C) LATANOPROST|TIMOLOL XALACOM 2.5ML C 34.58 34.5771 BOTT 1 BOTT PFI PFIZER CORPORATION STO BRYDEN STOKES LTD B 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS