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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 3294S PREPRATION H MULTI-SYMPTOM 0.25% | 1% CR (GSK/COL) PHENYLEPHRINE | PRAMOXINE PHENYLEPHRINE|PRAMOXINE PREPRATION H MULTI-SYMPTOM 26G A 12.69 12.69 CREAM 1 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 3294S PREPRATION H MULTI-SYMPTOM 0.25%|1% CR (GSK) PHENYLEPHRINE|P GLYCERINE|PHENYLEPHRINE|PRAMOXINE PREPRATION H MULTI-SYMPTOM 26G A 13.35 13.347 TUBE 1 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2024-04-01 2026-03-31 TOPICAL 0 ANTI-INFLAMMATORY AGENTS, TOPICAL