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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
42 3301AJ FURASONE 0.1% CR (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.20 6.20 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3301AW METHYLPREDNISOLONE 0.1% CR (KWA/ATB) METHYLPREDNISOLONE METHYLPREDNISOLONE 15G A 6.01 6.01 CREAM 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3301AX MOMETASONE 0.1% CR (KWA/ATB) MOMETASONE MOMETASONE 15G A 4.49 4.49 CREAM 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3301BC ELOCOM 0.1% CR (MSD/STO) MOMETASONE MOMETASONE ELOCOM 15G C 10.11 10.11 CREAM 0 TUBE MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE MOMETASONE ELOCOM 15G A 10.22 10.22 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2024-07-18 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-06
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE (C) MOMETASONE ELOCOM 15G C 10.22 10.2209 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-07-19 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-06
42 3301BC ELOCON 0.1% CR (MSD) MOMETASONE MOMETASONE ELOCON 15G C 10.22 10.22 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3301BE ADVANTAN 0.1% CR (LEO/COL) METHYLPREDNISOLONE METHYLPREDNISOLONE ADVANTAN 15G C 11.50 11.50 CREAM 0 TUBE LEO LEO LABORATORIES LTD. COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
42 3301BJ FLUTICA 0.05% CR (ARP) FLUTICASONE FLUTICA 10G A 3.26 3.26 TUBE 2 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
41 3301BK TROSONE 0.1% CR (AUR) MOMETASONE MOMETASONE TROSONE 15G A 5.0561 5.0561 TUBE 2 TUBE AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3302AA METHYLPREDNISOLONE 0.1% OINT (KWA/ATB) METHYLPREDNISOLONE METHYLPREDNISOLONE 15G A 6.50 6.50 OINT 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3302BC ELOCON 0.1% OINT (MSD/STO) MOMETASONE MOMETASONE ELOCON 15G C 11.93 11.93 OINT 0 TUBE MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE MOMETASONE ELOCON 15G A 12.04 12.0422 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2024-07-18 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-07
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE (C) MOMETASONE ELOCON 15G C 12.04 12.04 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-07-19 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-07
42 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE MOMETASONE ELOCON 15G C 12.04 12.04 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3302Z FURASONE 0.1% OINT (CAR/COL) MOMETASONE MOMETASONE FURASONE 15G A 5.16 5.16 OINT 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3302Z FURASONE 0.1% OINT (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.2 6.1978 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 3302Z FURASONE 0.1% OINT (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.20 6.20 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
41 33624 COLCHICINE 0.5MG TAB (CAM) COLCHICINE COLCHICINE 100'S A 15.63 0.1563 TAB 90 BOTT CAM MORNINGSIDE PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 4040 URICOSURIC AGENTS 2024-04-01 2026-03-31 ORAL 6 URICOSURIC AGENTS
40 33625 COLCHICINE 0.5MG TAB (CAM/AHI) COLCHICINE COLCHICINE 100'S A 26.91 0.27 TABLET 90 TAB CAM MORNINGSIDE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 4040 URICOSURIC AGENTS 2022-04-01 2024-03-31 Oral 6 ELECTROLYTIC, CALORIC, AND WATER BALANCE