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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 0292J CLINEX 150MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 3X10 A $9.65 $0.32 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 0294K CLINEX 300MG CAP (ARP/AHI) CLINDAMYCIN HCL CLINDAMYCIN HYDROCHLORIDE CLINEX 30'S A $18.76 $0.63 CAPSULE 28 CAP ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 08122820 LINCOMYCINS 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
40 07219 FLACORT 6MG TAB (ARP/AHI) DEFLAZACORT DEFLAZACORT FLACORT 3X10 C $8.97 $0.30 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
40 12148 NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN GLYCERYL TRINITRATE NITROCARD 200 DOSES A $17.61 $17.61 SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 241208 NITRATES AND NITRITES 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 23414 MATROPIN 2% EYE DR (ARP/AHI) HOMATROPINE HOMATROPINE MATROPIN 10ML A $14.11 $14.11 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2371H OXOZOLIN 0.05% NASAL DR (ARP/AHI) OXYMETAZOLI OXYMETAZOLINE OXOZOLIN 10ML A $4.57 $4.57 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2373G OXOZOLIN PAED 0.025% NASAL DR (ARP/AHI) OXYME OXYMETAZOLINE OXOZOLIN PAED 10ML A $4.05 $4.05 NASAL DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 NASAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2662E SONEXA 0.1% EYE DR (ARP/AHI) DEXAMETHASONE DEXAMETHASONE SONEXA 5ML B $4.57 $4.57 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 3653CS FLUTICASONE 27.5MCG NASAL SP (ARP/AHI) FLUTICASONE FLUTICASONE 120 DOSES A $12.99 $12.99 NASAL SPRAY 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5208 EENT ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 NASAL 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4253AR DERMOCIN 2% OINT (ARP/AHI) MUPIROCIN MUPIROCIN DERMOCIN 10G BQ $5.16 $5.16 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 4701AX SYSTEAR 0.4% | 0.3% EYE DR (ARP/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL SYSTEAR 10ML A $7.34 $7.34 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 4701AY DRYLIEF 1% EYE DR (ARP/AHI) CARBOXYMETHYLCELL CARBOXYMETHYLCELLULOSE DRYLIEF 10ML A $6.93 $6.93 EYE DROP 1 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 5281BV APROCIN 0.3% EYE DR (ARP/AHI) CIPROFLOXACIN CIPROFLOXACIN APROCIN 10ML BH $8.15 $8.15 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2022-09-30 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29
40 5281BX OPTIMOX 0.5% EYE DR (ARP/AHI) MOXIFLOXACIN MOXIFLOXACIN OPTIMOX 5ML BQ $8.70 $8.70 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 5282F T-MYCIN 0.3% OINT (ARP/AHI) TOBRAMYCIN TOBRAMYCIN T-MYCIN 3G BH $10.00 $10.00 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520404 EENT ANTIBACTERIALS 2022-04-01 2022-09-30 TOPICAL 0 EYE, EAR, NOSE AND THROAT PREPARATIONS 2022-03-29
40 56955 ACYVIR 3% EYE OINT (ARP/AHI) ACYCLOVIR ACYCLOVIR ACYVIR 5G A $8.02 $8.02 EYE OINTMENT 2 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520420 EENT ANTIVIRALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 57618 STAFEN 1MG TAB (ARP/AHI) KETOTIFEN KETOTIFEN STAFEN 10X10 A $14.84 $0.15 TABLET 60 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC B 481032 MAST CELL STABILISERS 2022-04-01 2024-03-31 Oral 6 RESPIRATORY TRACT AGENTS
40 5832F CONTINE CR 200MG TAB (ARP/AHI) THEOPHYLLINE THEOPHYLLINE CONTINE CR 10X10 A $8.13 $0.08 TABLET 90 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC B 8616 THEOPHYLLINES 2022-04-01 2024-03-31 Oral 6 SMOOTH MUSCLE RELAXANTS
40 62614 N-MYCIN 5% EYE DR (ARP/AHI) NATAMYCIN NATAMYCIN N-MYCIN 5ML BQ $20.99 $20.99 EYE DROP 0 BOTT ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520416 EENT ANTIFUNGALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 6561D MESAGUT 400MG TAB (ARP/AHI) MESALAZINE MESALAZINE MESAGUT 30'S BQ $16.91 $0.56 TABLET 0 TAB ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 5632 GI PROKINETIC AGENTS 2022-04-01 2024-03-31 Oral 6 GASTROINTESTINAL DRUGS