Drugs available on Contract - [FURASONE 0.1% OINT (CAR) MOMETASONE], []

Contract Number	42
Brand Code	3302Z
Brand Name	FURASONE 0.1% OINT (CAR) MOMETASONE
Active Ingredient	MOMETASONE
Trade Name	FURASONE
Package Size	15G
Formulary Category	A
Pkg Price	6.20
Unit Price	6.20
Strength	0.1%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	2
Package Description	BOX
Manufacturer Code	CAR
Manufacturer Name	CARLISLE LABORATORIES LTD
Agent Code	COL
Agent Name	AVENTA BARBADOS
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode	APPLY OD
SIGFactor	1
Dentist Allowed	N
Therapeutic Code	8406
Therapeutic Desc	ANTI-INFLAMMATORY AGENTS, TOPICAL
Status Description
Default Route	TOPICAL
Max Repeats	0
Therapeutic Head	ANTI-INFLAMMATORY AGENTS, TOPICAL
Amend Date