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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 4211W MICOSPEC BV 0.1% | 2% CR (CAR/COL) BETAMETHASONE | MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 3.81 3.81 CREAM 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 4211W MICOSPEC BV 0.1%|2% CR (CAR) BETAMETHASONE|MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 4 3.9959 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFECTIVES & ANTI-INFLAMMATORIES
42 4211W MICOSPEC BV 0.1%|2% CR (CAR) BETAMETHASONE|MICONAZOLE BETAMETHASONE|MICONAZOLE MICOSPEC BV 15G A 4.00 4.00 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2026-04-01 TOPICAL 0 ANTI-INFECTIVES & ANTI-INFLAMMATORIES
40 5231AD DAKTARIN 2% CR (JAC/STO) MICONAZOLE MICONAZOLE DAKTARIN 30G C 15.41 15.41 CREAM 0 TUBE JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-05-24 Delete from contract TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-04-12
41 5231Z MICAZOLE 2% CR (GPC) MICONAZOLE MICONAZOLE MICAZOLE 15G A 1.74 1.7397 TUBE 2 BOX GPC NEW GUYANA PHARMACEUTICAL CORP. LTD ATB ANSA TRADING BARBADOS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5231ZJ MICOSPEC 2% CR (CAR/COL) MICONAZOLE MICONAZOLE MICOSPEC 15G C 3.64 3.64 CREAM 0 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5231ZJ MICOSPEC 2% CR (CAR) MICONAZOLE (C) MICONAZOLE MICOSPEC 15G C 3.67 3.6697 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
42 5231ZJ MICOSPEC 2% CR (CAR) MICONAZOLE MICONAZOLE MICOSPEC 15G A 3.67 3.67 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 TOPICAL 0 ANTIFUNGALS TOPICAL
40 5231ZK MICONAZOLE 2% CR (CIP/AHI) MICONAZOLE MICONAZOLE 15G A 2.12 2.12 CREAM 2 TUBE CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 5233Q MICOSPEC 2% PWDR (CAR/COL) MICONAZOLE MICONAZOLE MICOSPEC 15G A 4.89 4.89 POWDER 2 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 5233Q MICOSPEC 2% POWDER (CAR) MICONAZOLE MICONAZOLE MICOSPEC 15G A 5.11 5.1104 BOTT 2 BOTT CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTIFUNGALS TOPICAL
42 5233Q MICOSPEC 2% POWDER (CAR) MICONAZOLE MICONAZOLE MICOSPEC 15G A 5.11 5.11 BOTT 2 BOTT CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 840408 ANTIFUNGALS TOPICAL 2026-04-01 TOPICAL 0 ANTIFUNGALS TOPICAL
40 52352 DAKTARIN 2% GEL (JAC/STO) MICONAZOLE MICONAZOLE DAKTARIN 78G BQ 28.27 28.27 GEL 0 TUBE JAC JANSSEN-CILAG STO BRYDEN STOKES LTD 840408 ANTIFUNGALS TOPICAL 2022-04-01 2022-05-24 Delete from contract Oral 0 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-04-12
41 52353 MICOGEL ORAL 2% GEL (CIP) MICONAZOLE MICONAZOLE MICOGEL ORAL 15G B 5.36 5.3551 TUBE 2 BOX CIP CIPLA LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTIFUNGALS TOPICAL
41 52354 MICOGEL 2% GEL (ARP) MICONAZOLE MICONAZOLE MICOGEL 15G B 5.36 5.36 TUBE 2 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2024-04-01 2026-03-31 ORAL 6 ANTIFUNGALS TOPICAL 2023-11-21
42 52354 MICOGEL ORAL 2% GEL (ARP) MICONAZOLE MICONAZOLE MICOGEL ORAL 15G B 4.65 4.65 TUBE 2 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840408 ANTIFUNGALS TOPICAL 2026-04-01 ORAL 6 ANTIFUNGALS TOPICAL
40 5561AV MICOPSEC 2% VAG CR (CAR/COL) MICONAZOLE MICONAZOLE MICOPSEC 45G A 15.22 15.22 VAGINAL CREA 1 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 081408 AZOLES 2022-04-01 2024-03-31 VAGINAL 0 ANTI-INFECTIVE AGENTS
41 5561AV MICOPSEC 2% VAG CR (CAR) MICONAZOLE MICONAZOLE MICOPSEC 45G A 17.67 17.6691 TUBE 1 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 081408 AZOLES 2024-04-01 2026-03-31 VAGINAL 0 AZOLES
42 5561AV MICOPSEC 2% VAG CR (CAR) MICONAZOLE MICONAZOLE MICOPSEC 45G C 17.67 17.67 TUBE 1 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 081408 AZOLES 2026-04-01 VAGINAL 0 AZOLES
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