Displaying 1 - 10 of 10
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 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 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