Displaying 1 - 19 of 19
| 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 | 23132 | MIOSTAT OCULAR 0.01% INJ (ALC/AHI) CARBACHOL | CARBACHOL | MIOSTAT OCULAR | 1.5ML VIAL | BQ | 59.94 | 59.94 | INJECTION | 0 | VIAL | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 524020 | EENT MIOTICS | 2022-04-01 | 2024-03-31 | IV | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 23132 | MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL | CARBACHOL | MIOSTAT OCULAR | 1.5ML VIAL | BQ | 55.18 | 55.182 | VIAL | 0 | VIAL | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 524020 | EENT MIOTICS | 2024-04-01 | 2026-03-31 | IV | 0 | EENT MIOTICS | |||||
| 41 | 3541AB | VITALUX PLUS TAB (ALC) MULTIVITAMINS (C) | MULTIVITAMINS | VITALUX PLUS | 30'S | C | 28.62 | 0.9541 | TAB | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 8828 | MULTIVITAMIN PREPARATIONS | 2024-04-01 | 2026-03-31 | ORAL | 0 | MULTIVITAMIN PREPARATIONS | |||||
| 40 | 40418 | B.S.S. SOLN (ALC/AHI) BALANCED SALT | BALANCED SALT | B.S.S. | 15ML | BQ | 12.67 | 12.67 | SOLUTION | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5236 | EENT UNCLASSIFIED | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 40418 | B.S.S. SOLN (ALC) BALANCED SALT (BQ) | BALANCED SALT | B.S.S. | 15ML | BQ | 12.99 | 12.9936 | BOTT | 10 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5236 | EENT UNCLASSIFIED | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 0 | EENT UNCLASSIFIED | |||||
| 40 | 40439 | B.S.S. PLUS SOLN (ALC/AHI) BALANCED SALT SOL | BALANCED SALT | B.S.S. PLUS | 500ML | BQ | 32.48 | 32.48 | SOLUTION | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5236 | EENT UNCLASSIFIED | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 4043A | B.S.S (BAG) SOLN (ALC/AHI) BALANCED SALT | BALANCED SALT | B.S.S (BAG) | 500ML | BQ | 29.33 | 29.33 | SOLUTION | 0 | BAG | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5236 | EENT UNCLASSIFIED | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4043A | B.S.S (BAG) SOLN (ALC) BALANCED SALT (BQ) | BALANCED SALT | B.S.S (BAG) | 500ML | BQ | 29.9 | 29.9016 | BAG | 10 | BAG | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5236 | EENT UNCLASSIFIED | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 0 | EENT UNCLASSIFIED | |||||
| 40 | 4701AP | TEARS NATURALE FORTE EYE DR (ALC/AHI) DEXTRAN | GLYCERINE | HYPROMELLOSE | DEXTRAN|GLYCERINE|HYPROMELLOSE | TEARS NATURALE FORTE | 15ML | C | 13.32 | 13.32 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 4701AQ | TEARS NATURALE II 0.1% | 0.3% EYE DR (ALC/AHI) DEXTRAN | HYPROMELLOSE | DEXTRAN 70|HYPROMELLOSE | TEARS NATURALE II | 15ML | C | 12.67 | 12.67 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AQ | TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN|HYPROMELLOS (C) | DEXTRAN 70|HYPROMELLOSE | TEARS NATURALE II | 15ML | C | 17.89 | 17.8866 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AR | SYSTANE 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE | 15ML | C | 17.75 | 17.75 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AR | SYSTANE 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400|PROPY (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE | 15ML | C | 20.25 | 20.2515 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AS | SYSTANE GEL DROPS 0.4% | 0.3% EYE DR (ALC/AHI) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE GEL DROPS | 10ML | C | 16.26 | 16.26 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AS | SYSTANE GEL DROPS 0.4%|0.3% EYE DR (ALC) (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE GEL DROPS | 10ML | C | 18.54 | 18.539 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AT | SYSTANE ULTRA 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE G More ... | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE ULTRA | 10ML | C | 12.64 | 12.64 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AT | SYSTANE ULTRA 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400 (C) | POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL | SYSTANE ULTRA | 10ML | C | 15.33 | 15.3313 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 6 | EENT DRUGS MISCELLANEOPUS | |||||
| 40 | 4701AU | SYSTANE BALANCE 0.6% EYE DR (ALC/AHI) PROPYLE | PROPYLENE GLYCOL | SYSTANE BALANCE | 10ML | C | 19.03 | 19.03 | EYE DROP | 0 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | Ophthalmic | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 41 | 4701AU | SYSTANE BALANCE 0.6% EYE DR (ALC) PROPYL (C) | PROPYLENE GLYCOL | SYSTANE BALANCE | 10ML | C | 21.69 | 21.6922 | BOTT | 1 | BOTT | ALC | ALCON LABORATORIES INC. | AHI | ARMSTRONG HEALTHCARE INC | 5292 | EENT DRUGS MISCELLANEOPUS | 2024-04-01 | 2026-03-31 | OPHTHALMIC | 0 | EENT DRUGS MISCELLANEOPUS | |||||