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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 4253AD BACTROBAN 2% OINT (GSK/COL) MUPIROCIN MUPIROCIN BACTROBAN 15G C 11.91 11.91 OINT 0 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 4253AD BACTROBAN 2% OINT (GSK) MUPIROCIN (C) MUPIROCIN BACTROBAN 15G C 13.1 13.1023 TUBE 2 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 840404 ANTIBIOTICS TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTIBIOTICS TOPICAL
42 4253AD BACTROBAN 2% OINT (GSK) MUPIROCIN MUPIROCIN BACTROBAN 15G C 13.75 13.75 TUBE 2 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 6 ANTIBIOTICS TOPICAL
40 4253AR DERMOCIN 2% OINT (ARP/AHI) MUPIROCIN MUPIROCIN DERMOCIN 10G BQ 5.16 5.16 OINT 0 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 4253AR DERMOCIN 2% OINT (ARP) MUPIROCIN (BQ) MUPIROCIN DERMOCIN 10G BQ 5.16 5.1648 TUBE 2 BOX ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2024-04-01 2026-03-31 TOPICAL 6 ANTIBIOTICS TOPICAL
40 4253AV SUPIROCIN 2% OINT (GLP/ATB) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 5.44 5.44 OINT 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ATB ANSA TRADING BARBADOS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 Change Local Agent TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22
42 4253AW SUPIROCIN 2% OINT (GLP) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 4.89 4.89 TUBE 2 BOX GLP GLENMARK PHARMACEUTICALS LTD AHI ARMSTRONG HEALTHCARE INC 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 0 ANTIBIOTICS TOPICAL
42 4253AX MUPIROCIN 2% OINT (CHC) MUPIROCIN MUPIROCIN 15G BQ 2.56 2.56 TUBE 2 CHC CARITAS HEALTHCARE PVT LTD STO BRYDEN STOKES LTD 840404 ANTIBIOTICS TOPICAL 2026-04-01 Add to Contract TOPICAL 0 ANTIBIOTICS TOPICAL 2026-03-05
42 4253BA SUPIROCIN 2% OINT (GLP) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 4.89 4.89 TUBE 2 TUBE GLP GLENMARK PHARMACEUTICALS LTD CWS CAPSULE WHOLESALE 840404 ANTIBIOTICS TOPICAL 2026-04-01 TOPICAL 0 ANTIBIOTICS TOPICAL
40 4253P SUPIROCIN 2% OINT (GLP/ALI) MUPIROCIN MUPIROCIN SUPIROCIN 15G BQ 5.44 5.44 OINT 0 TUBE GLP GLENMARK PHARMACEUTICALS LTD ALI ALL HEALTH INC 840404 ANTIBIOTICS TOPICAL 2022-04-01 2022-03-22 Delete from contract TOPICAL 6 SKIN-MUCOUS MEMBRANE PREPARATIONS 2022-03-22