Displaying 1 - 20 of 28
| 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 | |||||
| 40 | 3362E | COLCHICINE 0.5MG TAB (HAL/COL) | COLCHICINE | COLCHICINE | 100'S | A | $22.40 | $0.22 | TABLET | 90 | TAB | HAL | HALEWOOD CHEMICALS LTD. | COL | COLLINS LTD | 4040 | URICOSURIC AGENTS | 2022-04-01 | 2024-03-31 | Oral | 6 | ELECTROLYTIC, CALORIC, AND WATER BALANCE | |||||
| 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 | |||||
| 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 | |||||
| 40 | 41458 | ACULAR LS 0.4% EYE DR (ALL/COL) KETOROLAC | KETOROLAC | ACULAR LS | 5ML | C | $26.64 | $26.64 | EYE DROP | 0 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 520820 | EENT NSAID | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 42312 | SILVER NITRATE 95% STICK (HAL/COL) | SILVER NITRATE | SILVER NITRATE | 12'S | B | $108.60 | $9.05 | STICK | 0 | EACH | HAL | HALEWOOD CHEMICALS LTD. | COL | COLLINS LTD | 8436 | MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS | 2022-04-01 | 2024-03-31 | TOPICAL | 0 | SKIN-MUCOUS MEMBRANE PREPARATIONS | |||||
| 40 | 47014 | REFRESH LIQUIGEL 1% EYE DR (ALL/COL) HYPROMEL | CARBOXYMETHYLCELLULOSE | REFRESH LIQUIGEL | 15ML | A | $11.55 | $11.55 | EYE DROP | 1 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 6 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 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 | |||||
| 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 | |||||
| 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 | |||||
| 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 | |||||
| 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 | |||||
| 40 | 4701AV | REFRESH OPTIVE GEL 1% | 0.9% EYE DR (ALL/COL) CARBOXYMETHYLCELLULOSE | GLYCERINE | CARBOXYMETHYLCELLULOSE|GLYCERINE | REFRESH OPTIVE GEL | 10ML | C | $12.91 | $12.91 | EYE DROP | 0 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 4701B | REFRESH TEARS 0.5% EYE DR (ALL/COL) HYPROMELL | HYPROMELLOSE | REFRESH TEARS | 15ML | C | $11.55 | $11.55 | EYE DROP | 0 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 4701K | OPTIVE .05%C/0.9%G EYE DR (ALL/COL) CARBOXY/G | CARBOXYMETHYLCELLULOSE|GLYCERINE | OPTIVE | 15ML | C | $13.59 | $13.59 | EYE DROP | 0 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 5292 | EENT DRUGS MISCELLANEOPUS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||
| 40 | 51118 | PROPYLTHIOURACIL 50MG TAB (HAL/COL) | PROPYLTHIOURACIL | PROPYLTHIOURACIL | 100'S | A | $24.71 | $0.25 | TABLET | 270 | TAB | HAL | HALEWOOD CHEMICALS LTD. | COL | COLLINS LTD | 683608 | ANTI-THYROID AGENTS | 2022-04-01 | 2024-03-31 | Oral | 6 | HORMONES AND SYNTHETIC SUBSTITUTES | |||||
| 40 | 5511AE | SURE COMFORT 31GX5/16'' (ALM/PHA) INSULIN S | INSULIN SYRINGE | SURE COMFORT 31GX5|16'' | 100'S | A | $22.83 | $0.23 | 10 | EACH | ALM | ALLISON MEDICAL | PHA | PHARMACY SALES CARIBBEAN | B | 682008 | INSULINS | 2022-04-01 | 2024-03-31 | IV | 6 | HORMONES AND SYNTHETIC SUBSTITUTES | |||||
| 40 | 59511 | PRED-FORTE 1% EYE DR (ALL/COL) PREDNISOLONE | PREDNISOLONE | PRED-FORTE | 5ML | C | $17.67 | $17.67 | EYE DROP | 0 | BOTT | ALL | ALLERGAN INTERNATIONAL | COL | COLLINS LTD | 5208 | EENT ANTI-INFLAMMATORY AGENTS | 2022-04-01 | 2024-03-31 | OPHTHALMIC | 0 | EYE, EAR, NOSE AND THROAT PREPARATIONS | |||||