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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 4252W FUSIFEN 2% CR (FUR/ATB) FUSIDIC ACID FUSIDIC ACID FUSIFEN 15G A 2.91 2.91 CREAM 2 TUBE FUR FOURRTS LABORATORIES ATB ANSA TRADING BARBADOS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 4253AT FUSIFEN 2% OINT (FUR/ATB) FUSIDIC ACID FUSIDIC ACID FUSIFEN 15G A 2.72 2.72 OINT 2 TUBE FUR FOURRTS LABORATORIES ATB ANSA TRADING BARBADOS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS