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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 02316 DULERA 5MCG | 100MCG INHR (MSD/STO) FORMOTEROL | MOMETASONE FORMOTEROL|MOMETASONE DULERA 120 DOSES B 56.68 56.68 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02316 DULERA 5MCG|100MCG INHR (MSD) FORMOTEROL|MOMETASONE (C) FORMOTEROL|MOMETASONE DULERA 120 DOSES C 58.39 58.3896 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 02326 DULERA 200MCG/5MCG INHR (MSD/STO) MOMETASONE/ FORMOTEROL|MOMETASONE DULERA 120 DOSES B 59.26 59.26 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02326 DULERA 200MCG/5MCG INHR (MSD) MOMETASONE (B) FORMOTEROL|MOMETASONE DULERA 120 DOSES B 61.03 61.0264 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 3301AJ FURASONE 0.1% CR (CAR/COL) MOMETASONE MOMETASONE FURASONE 15G A 5.16 5.16 CREAM 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3301AJ FURASONE 0.1% CR (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.2 6.1978 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 3301AJ FURASONE 0.1% CR (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.20 6.20 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3301AX MOMETASONE 0.1% CR (KWA/ATB) MOMETASONE MOMETASONE 15G A 4.49 4.49 CREAM 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3301BC ELOCOM 0.1% CR (MSD/STO) MOMETASONE MOMETASONE ELOCOM 15G C 10.11 10.11 CREAM 0 TUBE MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE MOMETASONE ELOCOM 15G A 10.22 10.22 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2024-07-18 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-06
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE (C) MOMETASONE ELOCOM 15G C 10.22 10.2209 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-07-19 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-06
42 3301BC ELOCON 0.1% CR (MSD) MOMETASONE MOMETASONE ELOCON 15G C 10.22 10.22 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
41 3301BK TROSONE 0.1% CR (AUR) MOMETASONE MOMETASONE TROSONE 15G A 5.0561 5.0561 TUBE 2 TUBE AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3302BC ELOCON 0.1% OINT (MSD/STO) MOMETASONE MOMETASONE ELOCON 15G C 11.93 11.93 OINT 0 TUBE MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE MOMETASONE ELOCON 15G A 12.04 12.0422 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2024-07-18 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-07
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE (C) MOMETASONE ELOCON 15G C 12.04 12.04 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-07-19 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-06-07
42 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE MOMETASONE ELOCON 15G C 12.04 12.04 TUBE 2 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 2028-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
40 3302Z FURASONE 0.1% OINT (CAR/COL) MOMETASONE MOMETASONE FURASONE 15G A 5.16 5.16 OINT 2 TUBE CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3302Z FURASONE 0.1% OINT (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.2 6.1978 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL
42 3302Z FURASONE 0.1% OINT (CAR) MOMETASONE MOMETASONE FURASONE 15G A 6.20 6.20 TUBE 2 BOX CAR CARLISLE LABORATORIES LTD COL AVENTA BARBADOS 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2026-04-01 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL