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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 32934 PROCTO-GLYVENOL 40MG | 400MG SUPPOS (GSK/COL) LIDOCAINE | TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 4.73 0.95 SUPPOSITORY 5 SUPP GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 RECTAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 4.97 0.9949 SUPP 5 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 RECTAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 5'S A 5.22 1.04 SUPP 5 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 RECTAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3294B PROCTO-GLYVENOL CR (GSK/COL) TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.50 7.50 CREAM 1 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3294B PROCTO-GLYVENOL CR (GSK) TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.61 7.6113 TUBE 1 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 3294B PROCTO-GLYVENOL 40MG|400MG CR (GSK) LIDOCAINE|TRIBENOSIDE LIDOCAINE|TRIBENOSIDE PROCTO-GLYVENOL 30G A 7.99 7.99 TUBE 1 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 TOPICAL 6 ANTI-INFLAMMATORY AGENTS, TOPICAL