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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 2401A IDEW-FLO 1MG STRP (ENT/PHA) FLUORESCEIN FLUORESCEIN IDEW-FLO 100'S B 20.12 20.12 STRIP 0 STRP ENT ENTOD PHA PHARMACY SALES CARIBBEAN 5236 EENT UNCLASSIFIED 2022-04-01 2024-03-31 TOPICAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 2401A IDEW-FLO 1MG STRP (ENT) FLUORESCEIN FLUORESCEIN IDEW-FLO 100'S B 22.698 0.227 STRP 0 BOX ENT ENTOD PHA PHARMACY SALES CARIBBEAN 5236 EENT UNCLASSIFIED 2024-04-01 2026-03-31 TOPICAL 0 EENT UNCLASSIFIED
42 2401AA I-DEW FLO 1MG STRP (ENT) FLUORESCEIN FLUORESCEIN I-DEW FLO 100'S B 19.71 0.20 STRP 0 N/A ENT ENTOD PSB PHARMACEUTICAL SOLUTIONS BARBA 3658 OCULAR DISORDERS 2026-04-01 OPHTHALMIC 0 OCULAR DISORDERS