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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 5231ZG KETOZAL 2% CR (CAR) KETOCONAZOLE (C) KETOCONAZOLE KETOZAL 45G C 8.89 8.89 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
41 5231ZH CLODERM 1% CR (CAR) CLOTRIMAZOLE (C) CLOTRIMAZOLE CLODERM 15G C 3.07 3.0717 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
42 5231ZH CLODERM 1% CR (CAR) CLOTRIMAZOLE (C) CLOTRIMAZOLE CLODERM 15G C 3.18 3.18 TUBE 2 TUBE CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5231ZJ MICOSPEC 2% CR (CAR/COL) MICONAZOLE MICONAZOLE MICOSPEC 15G C 3.64 3.64 CREAM 0 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5231ZJ MICOSPEC 2% CR (CAR) MICONAZOLE (C) MICONAZOLE MICOSPEC 15G C 3.67 3.6697 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
42 5231ZJ MICOSPEC 2% CR (CAR) MICONAZOLE MICONAZOLE MICOSPEC 15G A 3.67 3.67 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5231ZK MICONAZOLE 2% CR (CIP/AHI) MICONAZOLE MICONAZOLE 15G A 2.12 2.12 CREAM 2 TUBE CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 52324 ECONADERM 1% SOLN (CAR/COL) ECONAZOLE ECONAZOLE ECONADERM 20ML A 5.16 5.16 SOLUTION 2 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 52324 ECONADERM 1% SOLN (CAR) ECONAZOLE ECONAZOLE ECONADERM 20ML A 5.38 5.3823 BOTT 2 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
42 52324 ECONADERM 1% SOLN (CAR) ECONAZOLE ECONAZOLE ECONADERM 20ML A 5.38 5.38 BOTT 2 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5232AA BATRAFEN NAIL LACQUER 8% (SFA/COL) CICLOPIROX OLAMINE CICLOPIROX OLAMINE BATRAFEN NAIL LACQUER 3ML C 33.98 33.98 0 BOTT SFA SANOFI AVENTIS COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 5232AC LAMISIL 1% SPRAY (GSK/COL) TERBINAFINE TERBINAFINE LAMISIL 30ML C 34.11 34.11 SPRAY 0 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5232AC LAMISIL 1% SPRAY (GSK) TERBINAFINE (C) TERBINAFINE LAMISIL 30ML C 35.8 35.8003 BOTT 0 BOTT GSK GLAXOSMITHKLINE COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5232AZ CANDID 1% EAR DR (GLP/ALI) CLOTRIMAZOLE CLOTRIMAZOLE CANDID 15ML A 6.80 6.80 EAR DROP 1 BOTT GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract OTIC 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5232BA KETOCONAZOLE 2% SHAMP (HEA/RXP) KETOCONAZOLE KETOCONAZOLE 100ML A 4.84 0.05 SHAMPOO 100 ML HEA HEALTH 2000 INC RXP RX PRO INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 5232BE KETOZAL 2% SHAMP (CAR/COL) KETOCONAZOLE KETOCONAZOLE KETOZAL 250ML C 20.66 0.08 SHAMPOO 0 ML CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5232BE KETOZAL 2% SHAMP (CAR) KETOCONAZOLE (C) KETOCONAZOLE KETOZAL 250ML C 21.69 0.0868 ML 100 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 081404 ALLYAMINES 2024-04-01 2026-03-31 TOPICAL 6 ALLYAMINES
42 5232BE KETOZAL 2% SHAMP (CAR) KETOCONAZOL (C) KETOCONAZOLE KETOZAL 250ML C 21.69 0.09 ML 100 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 081404 ALLYAMINES 2026-04-01 2028-03-31 TOPICAL 6 ALLYAMINES
40 5232BF TERBINAFINE 1% LOTION (AUR/AHI) TERBINAFINE TERBINAFINE 30ML C 5.08 5.08 LOTION 0 BOTT AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5232BF TERBINAFINE 1% LOTION (AUR) TERBINAFINE TERBINAFINE 30ML A 5.25 5.2464 BOTT 1 BOTT AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTIFUNGALS TOPICAL