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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 13911 SUFREXAL 2% GEL (JAC/STO) KETANSERIN KETANSERIN SUFREXAL 78G C 49.80 49.80 GEL 0 GEL JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 13911 SUFREXAL 2% GEL (JAC) KETANSERIN KETANSERIN SUFREXAL 78G C 49.8 49.7997 GEL 0 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2024-04-01 2026-03-31 TOPICAL 0 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
42 13911 SUFREXAL 2% GEL (JAC) KETANSERIN KETANSERIN SUFREXAL 78G C 49.80 49.80 TUBE 0 BOX JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2026-04-01 TOPICAL 0 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS