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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 4211W MICOSPEC BV 0.1% | 2% CR (CAR/COL) BETAMETHASONE | MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 3.81 3.81 CREAM 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 4211W MICOSPEC BV 0.1%|2% CR (CAR) BETAMETHASONE|MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 4 3.9959 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFECTIVES & ANTI-INFLAMMATORIES
42 4211W MICOSPEC BV 0.1%|2% CR (CAR) BETAMETHASONE|MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 4.00 4.00 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2026-04-01 TOPICAL 0 ANTI-INFECTIVES & ANTI-INFLAMMATORIES