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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
41 5591B WAXONIL 2%|15% EAR DR (SPC) PARADICHLOROBENZENE|TURPENTINE O PARADICHLOROBENZENE|TURPENTINE OIL WAXONIL 10ML BOTT A 6.4424 6.4424 BOTT 1 BOTT SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 5236 EENT UNCLASSIFIED 2024-04-01 2026-03-31 OTIC 6 EENT UNCLASSIFIED
42 5591B WAXONIL 2%|15% EAR DR (SPC) PARADICHLOROBENZENE|TURPENTINE O PARADICHLOROBENZENE|TURPENTINE OIL WAXONIL 10ML A 6.80 6.80 BOTT 1 BOTT SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OTIC 6 EENT DRUGS MISCELLANEOPUS
42 5591C SOLYEAR 8.4% EAR DR (JLP) PARADICHLOROBENZENE PARADICHLOROBENZENE SOLYEAR 10ML A 5.44 5.44 BOTT 1 BOTT JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 5292 EENT DRUGS MISCELLANEOPUS 2026-04-01 OTIC 6 EENT DRUGS MISCELLANEOPUS