Displaying 1 - 8 of 8
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 A9619 DIFFERIN 0.1% GEL (DPT/STO) ADAPALENE 15G C 30.36 0.1% 0 2022-04-01 2024-03-31 0
40 A9621 DIFFERIN 0.1% GEL (DPT/STO) ADAPALENE 45G C 65.08 0.1% 0 2022-04-01 2024-03-31 0
40 A9624 DIFFERIN PUMP 0.3% GEL (DPT/STO) ADAPALENE 45G C 204.74 0.3% 0 2022-04-01 2024-03-31 0
41 A9626 ADAPALENE 0.6% GEL (WAT) (C) 45G C 169.2157 0.6% 0 2024-04-01 2026-03-31 0
40 A9631 DIFFERIN 0.1% CR (DPT/STO) ADAPALENE 45G C 65.86 0.1% 0 2022-04-01 2024-03-31 0
40 A9632 DERIVA 0.1% CR (GLP/ALI) ADAPALENE 15G C 16.31 0.1% 0 2022-04-01 2022-03-22 Delete from contract 0
40 A9634 DERIVA 0.1% GEL (GLN/ALI) ADAPALENE 45G C 29.90 0.1% 0 2022-04-01 2024-03-31 0
40 A9635 DERIVA 0.1% CR (GLP/ATB) ADAPALENE 15G C 16.31 0.1% 0 2022-04-01 2024-03-31 Change Local Agent 0