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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
41 2681A HYDROCORTISONE 10MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 9.24 0.3081 TAB 120 BOTT TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-04-01 2024-12-16 ORAL 6 ADRENALS
41 2681A HYDROCORTISONE 10MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 17.59 0.5863 TAB 120 BOTT TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-12-17 2026-03-31 ORAL 6 ADRENALS 2024-11-26
42 2681B LEECORT 10MG TAB (JLP) HYDROCORTISONE HYDROCORTISONE LEECORT 100'S A 16.04 0.16 TAB 120 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 2028-03-31 ORAL 6 ADRENALS
41 26827 HYDROCORTISONE 20MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 17.83 0.5944 TAB 120 BOX TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-04-01 2024-12-16 ORAL 6 ADRENALS
41 26827 HYDROCORTISONE 20MG TAB (TEV) HYDROCORTISONE HYDROCORTISONE 30'S A 19.95 0.665 TAB 120 BOX TEV TEVA UK LTD. COL COLLINS LTD 6804 ADRENALS 2024-12-17 2026-03-31 ORAL 6 ADRENALS 2024-11-26
40 2682A HYDROCORTISONE 20MG TAB (SLS/AHI) HYDROCORTISONE HYDROCORTISONE 50'S A 75.90 1.52 TABLET 120 TAB SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 Oral 6 HORMONES AND SYNTHETIC SUBSTITUTES
42 2682A HYDROCORTISONE 20MG TAB (SLS) HYDROCORTISONE HYDROCORTISONE 50'S A 43.44 0.87 TAB 120 BLIS SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 2028-03-31 ORAL 6 ADRENALS
40 2683AJ HYDROCORTISONE 1% CR (KWA/ATB) HYDROCORTISONE HYDROCORTISONE 15G A 3.26 3.26 CREAM 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2022-09-30 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-30
41 2683AJ HYDROCORTISONE 1% CR (KWA) HYDROCORTISONE HYDROCORTISONE 15G A 3.56 3.561 TUBE 2 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
41 2683AS MECORT 1% CR (MPI) HYDROCORTISONE HYDROCORTISONE MECORT 15G A 2.91 2.9086 TUBE 2 TUBE MPI MEPRO PHARMACEUTICALS INTERNATIONAL LTD AHI ARMSTRONG HEALTHCARE INC 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 2683L HYDROSONE 1% CR (CAR/COL) HYDROCORTISONE HYDROCORTISONE HYDROSONE 15G A 5.16 5.16 CREAM 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 2683L HYDROSONE 1% CR (CAR) HYDROCORTISONE (C) HYDROCORTISONE HYDROSONE 15G C 5.6 5.5997 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 2683L HYDROSONE 1% CR (CAR) HYDROCORTISONE HYDROCORTISONE HYDROSONE 15G A 5.60 5.60 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 26843 HYDROCORTISONE 1% OINT (GPC) HYDROCORTISONE HYDROCORTISONE 15G A 3.13 3.1261 TUBE 2 BOX GPC NEW GUYANA PHARMACEUTICAL CORP. LTD ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 26848 HYDROCORTISONE 1% OINT (KWA/ATB) HYDROCORTISONE HYDROCORTISONE 15G A 3.26 3.26 OINT 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2022-09-30 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-30
41 26848 HYDROCORTISONE 1% OINT (KWA) HYDROCORTISONE HYDROCORTISONE 15G A 3.56 3.561 TUBE 2 BOX KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 2684L HYDROSONE 1% OINT (CAR/COL) HYDROCORTISONE HYDROCORTISONE HYDROSONE 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
42 2684L HYDROSONE 1% OINT (CAR) HYDROCORTISONE HYDROCORTISONE HYDROSONE 15G A 5.60 5.60 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
42 26853 HISONE 5MG TAB (SLS) HYDROCORTISONE HYDROCORTISONE HISONE 20X10 A 37.30 0.19 TAB 120 BLIS SLS SAMARTH LIFE SCIENCES AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2026-04-01 2028-03-31 ORAL 6 ADRENALS
40 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR/AHI) HYDROCORTISONE SODIUM SUCCINATE HYDROCORTISONE SOD SUCC 100MG VIAL B 1.98 1.98 INJECTION 0 VIAL CIR CIRON PHARMA AHI ARMSTRONG HEALTHCARE INC 6804 ADRENALS 2022-04-01 2024-03-31 IV 0 HORMONES AND SYNTHETIC SUBSTITUTES