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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 3261B VIDENE ANTISEPTIC 1% SOLN (ECO/COL) POVIDONE POVIDONE IODINE VIDENE ANTISEPTIC 500ML B 13.59 0.03 SOLUTION 0 ML ECO ECOLAB LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 3262E VIDENE SURGICAL SCRUB 0.75% (ECO/COL) POVIDO POVIDONE IODINE VIDENE SURGICAL SCRUB 500ML B 15.85 0.03 SCRUB 0 ML ECO ECOLAB LTD COL COLLINS LTD 840492 ANTI-INFECTIVES TOPICAL MISCELLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS
40 4631B AQUAGEL (ECO/COL) LUBRICATING JELLY GLYCERINE AQUAGEL 82G B 3.29 3.29 0 TUBE ECO ECOLAB LTD COL COLLINS LTD 8436 MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS