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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
40 42536 BNT 500U | 3MG | 2MG OINT (CAR/COL) BACITRACIN | NE BACITRACIN|NEOMYCIN|TYROTHRICIN BNT 15G A 8.26 8.26 OINT 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 42536 BNT 500U|3MG|2MG OINT (CAR) BACITRACIN|N BACITRACIN|NEOMYCIN|TYROTHRICIN BNT 15G A 8.48 8.4812 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840404 ANTIBIOTICS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIBIOTICS TOPICAL
42 42536 BNT 500U/G|3MG/G|2MG/G OINT (CAR) BACITRACIN|NEOMYCIN|TYROTH BACITRACIN|NEOMYCIN|TYROTHRICIN BNT 15G A 8.48 8.48 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 0 ANTIBIOTICS TOPICAL