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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 23611 TROPICAMIDE MINIMS 1% EYE DR (CAM) (B) TROPICAMIDE TROPICAMIDE MINIMS 20X0.5ML B 82.53 4.1264 BOX 20 AMPP CAM MORNINGSIDE PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 5224 EENT MYDRIATICS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT MYDRIATICS
40 23613 TROPICAMIDE MINIMS 1% EYE DR (CAM/STO) TROPICAMIDE TROPICAMIDE MINIMS 20X0.5ML B 94.73 4.74 EYE DROP 0 AMP CAM MORNINGSIDE PHARMACEUTICALS STO BRYDEN STOKES LTD 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
42 2362A TRIASOL 1% EYE DR (ASL) TROPICAMIDE TROPICAMIDE TRIASOL 10ML B 11.55 11.55 BOTT 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5224 EENT MYDRIATICS 2026-04-01 Add to Contract as Cat B OPHTHALMIC 0 EENT MYDRIATICS 2025-12-04
40 2362G TROPICAMIDE 1% EYE DR (AKI/AHI) TROPICAMIDE TROPICAMIDE 15ML A 39.20 39.20 EYE DROP 1 BOTT AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2362J TROPICAMIDE 1% EYE DR (AKI) TROPICAMIDE TROPICAMIDE 15ML A 44.06 44.064 BOTT 1 BOTT AKI AKORN INC. AHI ARMSTRONG HEALTHCARE INC 5224 EENT MYDRIATICS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT MYDRIATICS