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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 5231DU CELAMINA 1% CR (GLP/ALI) CICLOPIROX OLAMINE CICLOPIROX OLAMINE CELAMINA 20G A 6.80 6.80 CREAM 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
40 5231EV CELAMINA 1% CR (GLP/ATB) CICLOPIROX OLAMINE CICLOPIROX OLAMINE CELAMINA 20G A 6.80 6.80 CREAM 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 Change Local Agent TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
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