Displaying 1 - 12 of 12
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 A9619 DIFFERIN 0.1% GEL (DPT/STO) ADAPALENE ADAPALENE DIFFERIN 15G C 30.36 30.36 GEL 0 TUBE DPT DPT LABORATORIES INC/GALDERMA STO BRYDEN STOKES LTD 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 A961A DERIVA 0.1% GEL (GLP) ADAPALENE (C) ADAPALENE DERIVA 15G C 18.35 18.35 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 TOPICAL 0 IMMUNOSUPPRESSIVE AGENTS
42 A961A DERIVA 0.1% GEL (GLP) ADAPALENE (C) ADAPALENE DERIVA 15G C 17.67 17.67 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 TOPICAL 0 IMMUNOSUPPRESSIVE AGENTS
42 A961C DERIVA 0.1% GEL (GLP) ADAPALENE (C) ADAPALENE DERIVA 15G C 17.67 17.67 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 8428 KERATOLYTICS 2026-04-01 TOPICAL 0 KERATOLYTICS
40 A9621 DIFFERIN 0.1% GEL (DPT/STO) ADAPALENE ADAPALENE DIFFERIN 45G C 65.08 65.08 GEL 0 TUBE DPT DPT LABORATORIES INC/GALDERMA STO BRYDEN STOKES LTD 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 A9624 DIFFERIN PUMP 0.3% GEL (DPT/STO) ADAPALENE ADAPALENE DIFFERIN PUMP 45G C 204.74 204.74 GEL 0 BOTT DPT DPT LABORATORIES INC/GALDERMA STO BRYDEN STOKES LTD 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 A9626 ADAPALENE 0.6% GEL (WAT) (C) ADAPALENE ADAPALENE 45G C 169.2157 169.2157 TUBE 0 TUBE WAT WATSON (ACTAVIS) PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 8428 KERATOLYTICS 2024-04-01 2026-03-31 TOPICAL 0 KERATOLYTICS
42 A9628 DERIVA 0.1% GEL (GLP) ADAPALENE (C) ADAPALENE DERIVA 45G C 14.95 14.95 TUBE 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 8428 KERATOLYTICS 2026-04-01 TOPICAL 0 KERATOLYTICS
40 A9631 DIFFERIN 0.1% CR (DPT/STO) ADAPALENE ADAPALENE DIFFERIN 45G C 65.86 65.86 CREAM 0 TUBE DPT DPT LABORATORIES INC/GALDERMA STO BRYDEN STOKES LTD 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 A9632 DERIVA 0.1% CR (GLP/ALI) ADAPALENE ADAPALENE DERIVA 15G C 16.31 16.31 CREAM 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 8428 KERATOLYTICS 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 A9634 DERIVA 0.1% GEL (GLN/ALI) ADAPALENE ADAPALENE DERIVA 45G C 29.90 29.90 GEL 0 TUBE GLN GLAND ALI ALL HEALTH INC 8428 KERATOLYTICS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 A9635 DERIVA 0.1% CR (GLP/ATB) ADAPALENE ADAPALENE DERIVA 15G C 16.31 16.31 CREAM 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 8428 KERATOLYTICS 2022-04-01 2024-03-31 Change Local Agent TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22