Displaying 1 - 7 of 7
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 5621D DERMOVATE 0.05% CR (GSK/COL) CLOBETASOL 30G C 23.92 0.05% 0 2022-04-01 2024-03-31 0
41 5621D DERMOVATE 0.05% CR (GSK) CLOBETASOL (C) 30G C 26.3134 0.05% 0 2024-04-01 2026-03-31 0
40 5621E DERMOVATE 0.05% OINT (GSK/COL) CLOBETASOL 30G C 23.92 0.05% 0 2022-04-01 2024-03-31 0
41 5621E DERMOVATE 0.05% OINT (GSK) CLOBETASOL (C) 30G C 26.3134 0.05% 0 2024-04-01 2026-03-31 0
40 5621P CLOBETASOL 0.05% LOT (CHC/ATB) 60ML C 6.96 0.05% 0 2022-04-01 2024-03-31 0
40 56222 CLOBETASOL 0.05% SHAMP (WOC/AHI) 50ML C 70.68 0.05% 0 2022-04-01 2024-03-31 0
41 56223 CLOBETASONE 0.05% SHAMP (GLP) CLOB (C) 100ML C 48.93 0.05% 1 2024-04-01 2026-03-31 0