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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 5232BS CANESTEN 1% CR (BSP/AHI) COTRIMAZOLE COTRIMAZOLE CANESTEN 15G A 9.27 9.27 CREAM TUBE BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2023-02-24 2024-03-31 Add to Contract as Cat A Topical ANTIFUNGALS TOPICAL 2023-02-24