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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 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 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