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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 5131L DUOTRAV 0.5% | 0.004% EYE DR (NVS/COL) TIMOLOL | TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.46 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 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI (C) TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.4568 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 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI TIMOLOL|TRAVOPROST DUOTRAV 2.5ML C 32.46 32.46 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
41 5131P T BET PRES. FREE 0.5%|0.004% EYE DR (AKU) TIMOLOL|TRAVOPROST (C) TIMOLOL|TRAVOPROST T BET PRES. FREE 3ML C 11.42 11.417 BOTT 1 BOTT AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 OPHTHALMIC 6 ANTIGLAUCOMA AGENTS MISCELLANEOUS
42 5131P T BET PRES. FREE 0.5%|0.004% EYE DR (AKU) TIMOLOL|TRAVOPROST TIMOLOL|TRAVOPROST T BET PRES. FREE 3ML BQ 11.44 11.44 BOTT 1 BOTT AKU AKUMS DRUGS AND PHARMACEUTICALS PSB PHARMACEUTICAL SOLUTIONS BARBA 524092 ANTIGLAUCOMA AGENTS MISCELLANEOUS 2026-04-01 OPHTHALMIC 0 ANTIGLAUCOMA AGENTS MISCELLANEOUS
40 A5319 GLAUCOPROST 0.004% EYE DR (LPO/COL) TRAVOPROS TRAVOPROST GLAUCOPROST 3ML A 10.60 10.60 EYE DROP 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A5319 GLAUCOPROST 0.004% EYE DR (LPO) TRAVOPRO (C) TRAVOPROST GLAUCOPROST 3ML C 11.66 11.6616 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A5319 GLAUCOPROST 0.004% EYE DR (LPO) TRAVOPRO TRAVOPROST GLAUCOPROST 3ML C 17.67 17.67 BOTT 1 BOTT LPO LABORATORIOS POEN S.A. COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
40 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS/COL) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.87 10.87 EYE DROP 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.87 10.8733 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL COLLINS LTD B 524028 EENT PROSTAGLANDIN ANALOGS 2024-04-01 2026-03-31 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS
42 A531AZ TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST TRAVOPROST TRAVATAN BAK 2.5ML A 10.82 10.82 BOTT 1 BOTT NVS NOVARTIS CARIBE SA COL AVENTA BARBADOS B 524028 EENT PROSTAGLANDIN ANALOGS 2026-04-01 OPHTHALMIC 6 EENT PROSTAGLANDIN ANALOGS