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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
42 60717 KLION D 100MG|100MG VAG OV (CHW) METRONI METRONIDAZOLE|MICONAZOLE KLION D 10'S A 11.15 11.15 PACK 1 BLIS CHW CHEMICAL WORKS OF GEDEON RICHTER LTD AHI ARMSTRONG HEALTHCARE INC 081492 ANTIFUNGALS, MISCELLANEOUS 2026-04-01 VAGINAL 0 ANTIFUNGALS, MISCELLANEOUS
41 6071B GYNOTRAN 750MG|200MG OV (EXE) METRONIDAZOLE|MICONAZOLE METRONIDAZOLE|MICONAZOLE GYNOTRAN 7'S A 22.13 22.1272 PACK 1 BOX EXE EXELTIS ILAC COL COLLINS LTD 9244 IMMUNOSUPPRESSIVE AGENTS 2024-04-01 2026-03-31 Vaginal 0 IMMUNOSUPPRESSIVE AGENTS
42 6071B GYNOTRAN 750MG|200MG OV (EXE) METRONIDAZOLE|MICONAZOLE METRONIDAZOLE|MICONAZOLE GYNOTRAN 7'S A 22.13 22.13 PACK 1 BLIS EXE EXELTIS ILAC COL AVENTA BARBADOS 9244 IMMUNOSUPPRESSIVE AGENTS 2026-04-01 VAGINAL 0 IMMUNOSUPPRESSIVE AGENTS
42 6071C DREZ-V 1%|2% GEL (STA) METRONIDAZOLE|MICONAZOLE METRONIDAZOLE|MICONAZOLE DREZ-V 30G A 6.85 6.85 TUBE 1 TUBE STA STEDMAN PHARMACEUTICALS PVT LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081492 ANTIFUNGALS, MISCELLANEOUS 2026-04-01 VAGINAL 0 ANTIFUNGALS, MISCELLANEOUS