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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 01243 OPTOMYCIN 0.5% EYE DR (ASL/PHA) CHLORAMPHENIC CHLORAMPHENICOL OPTOMYCIN 10ML C $4.08 $4.08 EYE DROP 0 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 03248 GENOPTIC 0.3% EYE DR (ASL/PHA) GENTAMICIN GENTAMICIN GENOPTIC 5ML BQ $4.08 $4.08 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 520404 EENT ANTIBACTERIALS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 07141 ATROPINE SULPHATE 1% EYE DR (ASL/PHA) ATROPINE SULPHATE ATROPINE SULPHATE 10ML A $11.66 $11.66 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5224 EENT MYDRIATICS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 22411 FRAMOPTIC D EYE DR (ASL/PHA) DEX/FRAMY/GRAMI DEXAMETHASONE|FRAMYCETIN|GRAMICIDIN FRAMOPTIC D 10ML C $8.07 $8.07 EYE DROP 0 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 2411B HYPROMELLOSE 0.3% EYE DR (ASL/PHA) HYPROMELLOSE HYPROMELLOSE 10ML A $3.75 $3.75 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5292 EENT DRUGS MISCELLANEOPUS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 40613 ALLEREX 0.05% | 0.04% EYE DR (ASL/PHA) ANTAZOLI ANTAZOLINE|TETRAHYDROZOLINE ALLEREX 10ML A $5.79 $5.79 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5232 EENT VASOCONSTRICTORS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 6451M MAXISPORIN 1MG/ML | 3MG EYE DR (ASL/PHA) DEXAMETHASONE | NEOMYCIN | POLYMYXIN B DEXAMETHASONE|NEOMYCIN|POLYMYXIN B MAXISPORIN 5ML BQ $5.52 $5.52 EYE DROP 0 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5206 ANTIBACTERIAL-ANTI-INFLAMMATORY AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS
40 A7318 ELEVE 0.1% EYE DR (ASL/PHA) OLOPATADINE OLOPATADINE ELEVE 5ML A $6.96 $6.96 EYE DROP 1 BOTT ASL ASHFORD LABORATORIES LTD PHA PHARMACY SALES CARIBBEAN 5202 ANTIALLERGIC AGENTS 2022-04-01 2024-03-31 OPHTHALMIC 6 EYE, EAR, NOSE AND THROAT PREPARATIONS