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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
41 5281BY T-MYCIN 0.3% EYE DR (ARP) TOBRAMYCI (BH) TOBRAMYCIN T-MYCIN 5ML BH 5.44 5.4366 BOTT 2 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5281CB TOBREX 0.3% EYE DR (NVS/COL) TOBRAMYCIN TOBRAMYCIN TOBREX 5ML C 23.30 23.30 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281CB TOBREX 0.3% EYE DR (NVS) TOBRAMYCIN (C) TOBRAMYCIN TOBREX 5ML C 16.31 16.3099 BOTT 2 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
42 5281CS TOBRACID 0.3% EYE DR (SHC) TOBRAMYCIN TOBRAMYCIN TOBRACID 5ML C 2.77 2.77 BOTT 2 BOTT SHC SION HEALTHCARE PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5281P GOTABIOTIC 0.3% EYE DR (LPO/COL) TOBRAMY TOBRAMYCIN GOTABIOTIC 5ML BH 7.34 7.34 EYE DROP 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 Ophthalmic 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5281P GOTABIOTIC 0.3% EYE DR (LPO) TOBRAMYCIN (BH) TOBRAMYCIN GOTABIOTIC 5ML BH 7.42 7.421 BOTT 2 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
42 5281P GOTABIOTIC 0.3% EYE DR (LPO) TOBRAMYCIN TOBRAMYCIN GOTABIOTIC 5ML C 13.59 13.59 BOTT 2 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS 520404 EENT ANTIBACTERIALS 2026-04-01 OPHTHALMIC 6 EENT ANTIBACTERIALS
40 5282F T-MYCIN 0.3% OINT (ARP/AHI) TOBRAMYCIN TOBRAMYCIN T-MYCIN 3G BH 10.00 10.00 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2022-09-30 TOPICAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29
41 5282F T-MYCIN 0.3% OINT (ARP) TOBRAMYCIN (BH) TOBRAMYCIN T-MYCIN 3G BH 5.38 5.3823 TUBE 2 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 TOPICAL 6 EENT ANTIBACTERIALS
40 5282G TOBREX 0.3% EYE OINT (NVS/COL) TOBRAMYCIN TOBRAMYCIN TOBREX 3.5G BH 15.49 15.49 EYE OINTMENT 0 TUBE NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 5282G TOBREX 0.3% EYE OINT (NVS) TOBRAMYC (C) TOBRAMYCIN TOBREX 3.5G C 15.49 15.4944 TUBE 2 BOX NVS NOVARTIS CARIBE SA COL COLLINS LTD 520404 EENT ANTIBACTERIALS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT ANTIBACTERIALS
42 5282G TOBREX 0.3% EYE OINT (NVS) TOBRAMYC TOBRAMYCIN TOBREX 3.5G C 15.49 15.49 TUBE 2 BOX NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 520404 EENT ANTIBACTERIALS 2026-04-01 OPHTHALMIC 6 EENT ANTIBACTERIALS
42 5282J TOBRACID 0.3% EYE OINT (HAN) TOBRAMYCIN TOBRAMYCIN TOBRACID 3G BH 2.80 2.80 TUBE 2 TUBE HAN HANUCHEM LABORATORIES PSB PHARMACEUTICAL SOLUTIONS BARBA 520404 EENT ANTIBACTERIALS 2026-04-01 OPHTHALMIC 0 EENT ANTIBACTERIALS
41 5422G TOBRAMYCIN 40MG/ML INJ (DIL) (BQ) TOBRAMYCIN TOBRAMYCIN 25X2ML BQ 482.39 19.2958 VIAL 0 BOX DIL FRESENIUS KABI AHI ARMSTRONG HEALTHCARE INC 081202 AMINOGLYCOSIDES 2024-04-01 2026-03-31 IV 0 AMINOGLYCOSIDES
40 5422J TOCIN 40MG/ML INJ (UBI/RXP) TOBRAMYCIN TOBRAMYCIN TOCIN 2ML VIAL BQ 8.97 8.97 INJECTION 0 VIAL UBI UNITED BIOTECH (P) LIMITED RXP RX PRO INC 081202 AMINOGLYCOSIDES 2022-04-01 2024-03-31 IV 6 ANTI-INFECTIVE AGENTS
41 77013 GOTABIOTIC F 0.1%|0.3% EYE DR (LPO) DEXAMETHASONE|TOBRAMYCIN (C) DEXAMETHASONE|TOBRAMYCIN GOTABIOTIC F 5ML C 7.58 7.5841 BOTT 0 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 ORAL 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 7701D DEXAMETHASONE/TOBRAMYCIN EYE DR (CIR/AHI) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.16 5.16 EYE DROP 0 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 7701D DEXAMETHASONE|TOBRAMYCIN 0.1%|0.3% EYE DR (CIR) (BQ) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.16 5.1648 BOTT 0 BOTT CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2024-04-01 2026-03-31 OPHTHALMIC 0 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS
40 7701E DEXAMETHASONE/TOBRAMYCIN EYE DR (KWA/ATB) DEXAMETHASONE|TOBRAMYCIN DEXAMETHASONE|TOBRAMYCIN 5ML BQ 5.41 5.41 EYE DROP 0 BOTT KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 7701H TOBRADEX 0.1% | 0.3% EYE DR (NVS/COL) DEXAMETHA DEXAMETHASONE|TOBRAMYCIN TOBRADEX 5ML C 21.09 21.09 EYE DROP 0 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS