|
|
42
|
2362A
|
TRIASOL 1% EYE DR (ASL) TROPICAMIDE
|
10ML
|
B
|
11.55
|
1%
|
1
|
2026-04-01
|
|
No
|
No
|
Add to Contract as Cat B
|
0
|
|
|
40
|
2362G
|
TROPICAMIDE 1% EYE DR (AKI/AHI)
|
15ML
|
A
|
39.20
|
1%
|
1
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
2362J
|
TROPICAMIDE 1% EYE DR (AKI)
|
15ML
|
A
|
44.064
|
1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
41
|
23716
|
XYLOMETAZOLINE 0.1% NASAL DR (KWA)
|
15ML
|
A
|
3.561
|
0.1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
40
|
23717
|
XYLOMETAZOLINE 0.1% NASAL DR (CIR/AHI)
|
10ML
|
A
|
2.66
|
0.1%
|
1
|
2022-04-01
|
2022-09-30
|
|
|
|
0
|
|
|
40
|
2371E
|
OTRIVINE 0.1% NASAL DR (GSK/COL) XYLOMETAZOLI
|
10ML
|
A
|
5.79
|
0.1%
|
1
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
2371E
|
OTRIVINE 0.1% NASAL DR (GSK) XYLOMETAZOL (C)
|
10ML
|
C
|
6.089
|
0.1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
42
|
2371E
|
OTRIVINE 0.1% NASAL DR (GSK) XYLOMETAZOL
|
10ML
|
C
|
6.39
|
0.1%
|
1
|
2026-04-01
|
|
No
|
No
|
|
0
|
|
|
40
|
2371H
|
OXOZOLIN 0.05% NASAL DR (ARP/AHI) OXYMETAZOLI
|
10ML
|
A
|
4.57
|
0.05%
|
1
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
2371H
|
OXOZOLIN 0.05% NASAL DR (ARP) OXYME
|
10ML
|
A
|
4.9473
|
0.05%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
41
|
2371M
|
AFRIN 0.05% NASAL DR (BSP) OXYMETAZOLINE (C)
|
15ML
|
C
|
13.4557
|
0.05%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
42
|
2371P
|
XYLOMETAZOLINE 0.1% NASAL DR (FSB)
|
15ML
|
A
|
1.50
|
0.1%
|
1
|
2026-04-01
|
|
No
|
No
|
Add to Contract as Cat A
|
0
|
|
|
40
|
23728
|
OTRIVINE MDI 0.1% NASAL SP (GSK/COL) XYLOMETA
|
10ML
|
C
|
4.38
|
0.1%
|
0
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
23728
|
OTRIVINE MDI 0.1% NASAL SP (GSK) XYLOMET (C)
|
10ML
|
C
|
4.594
|
0.1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
42
|
23728
|
OTRIVINE MDI 0.1% NASAL SP (GSK) XYLOMET
|
10ML
|
C
|
4.59
|
0.1%
|
1
|
2026-04-01
|
|
No
|
No
|
|
0
|
|
|
40
|
2372K
|
OTRIVINE 0.1% NASAL SP (GSK/COL) XYLOMETAZOLI
|
10ML
|
C
|
4.78
|
0.1%
|
0
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
2372K
|
OTRIVINE 0.1% NASAL SP (GSK) XYLOMETAZOL (C)
|
10ML
|
C
|
5.0289
|
0.1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
42
|
2372K
|
OTRIVINE 0.1% NASAL SP (GSK) XYLOMETAZOL
|
10ML
|
C
|
5.27
|
0.1%
|
1
|
2026-04-01
|
|
No
|
No
|
|
0
|
|
|
41
|
2372T
|
XYLOMETAZOLINE 0.1% NASAL SP (KWA)
|
10ML
|
A
|
2.963
|
0.1%
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
40
|
2372U
|
XYLOMETAZOLINE 0.1% NASAL SP (FSB/ATB)
|
10ML
|
A
|
3.53
|
0.1%
|
1
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
