Displaying 1 - 11 of 11
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 2551C FLEET ENEMA ADULT 7G | 19G (FLE/AHI) SODIUM BIPHOSPHATE | SODIUM PHOSPHATE SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA ADULT 133ML A 2.23 2.23 2 ENMA FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 6 GASTROINTESTINAL DRUGS 2021-12-17
41 2551C FLEET ENEMA ADULT 7G|19G ENEMA (FLE) SODIUM BIPHOSPHATE|SODI SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA ADULT 133ML A 2.94 2.9358 ENMA 2 BOX FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2024-04-01 2026-03-31 RECTAL 6 CATHARTICS AND LAXATIVES
40 25527 FLEET ENEMA PAED 3.5G | 9.5G (FLE/AHI) SODIUM SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA PAED 66ML B 5.79 5.79 0 ENMA FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 0 GASTROINTESTINAL DRUGS 2021-12-17
41 25527 FLEET ENEMA PAED 3.5G|9.5G (FLE) SODIUM SODIUM BIPHOSPHATE|SODIUM PHOSPHATE FLEET ENEMA PAED 66ML A 3.26 3.262 ENMA 2 BOX FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2024-04-01 2026-03-31 RECTAL 6 CATHARTICS AND LAXATIVES
40 3301BE ADVANTAN 0.1% CR (LEO/COL) METHYLPREDNISOLONE METHYLPREDNISOLONE ADVANTAN 15G C 11.50 11.50 CREAM 0 TUBE LEO LEO LABORATORIES LTD. COL COLLINS LTD 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 4091R GLYCERINE ADULT 2G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE ADULT 12'S A 2.47 0.21 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 6 GASTROINTESTINAL DRUGS
40 4092H GLYCERINE PAED 1G SUPPOS (FLE/AHI) GLYCERINE GLYCERINE GLYCERINE PAED 12'S A 2.88 0.24 SUPPOSITORY 12 SUPP FLE C.B. FLEET & CO. INC., AHI ARMSTRONG HEALTHCARE INC 5612 CATHARTICS AND LAXATIVES 2022-04-01 2024-03-31 RECTAL 0 GASTROINTESTINAL DRUGS
40 42117 SCHEDERMA 1MG | 10MG | 5MG CR (LEO/COL) DIFLUCORT DIFLUCORTOLONE|ISOCONAZOLE|NEOMYCIN SCHEDERMA 15G C 13.78 13.78 CREAM 0 TUBE LEO LEO LABORATORIES LTD. COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
41 42117 SCHEDERMA 1MG|10MG|5MG CR (LEO) DI (C) DIFLUCORTOLONE|ISOCONAZOLE|NEOMYCIN SCHEDERMA 15G C 21.1 21.1 TUBE 2 BOX LEO LEO LABORATORIES LTD. COL COLLINS LTD 8410 ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2024-04-25 2026-03-31 TOPICAL ANTI-INFECTIVES & ANTI-INFLAMMATORIES 2024-04-25
40 4252F FUCIDIN 2% CR (LEO/COL) FUSIDIC ACID FUSIDIC ACID FUCIDIN 15G C 6.71 6.71 CREAM 0 TUBE LEO LEO LABORATORIES LTD. COL COLLINS LTD 840404 ANTIBIOTICS TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 52614 ONE-ALPHA 0.25MCG CAP (LEO/COL) ALFACALCIDOL ALFACALCIDOL ONE-ALPHA 100'S A 42.13 0.42 CAPSULE 120 CAP LEO LEO LABORATORIES LTD. COL COLLINS LTD 8816 VITAMIN D 2022-04-01 2024-03-31 Oral 6 VITAMINS