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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 56222 CLOBETASOL 0.05% SHAMP (WOC/AHI) CLOBETASOL CLOBETASOL 50ML C 70.68 70.68 SHAMPOO 0 BOTT WOC WOCKHARD LTD INDIA AHI ARMSTRONG HEALTHCARE INC 8406 ANTI-INFLAMMATORY AGENTS, TOPICAL 2022-04-01 2024-03-31 TOPICAL 0 SKIN-MUCOUS MEMBRANE PREPARATIONS