Displaying 1 - 11 of 11
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 0314B FUSIDIC ACID DRESSING 1% (LDP/AHI) 10'S A 19.14 1% 10 2022-04-01 2024-03-31 0
41 0314B FUSIDIC ACID DRESSING 1% DRESSING (LDP) 10'S A 1.8974 1% 10 2024-04-01 2026-03-31 6
40 4252F FUCIDIN 2% CR (LEO/COL) FUSIDIC ACID 15G C 6.71 2% 0 2022-04-01 2024-03-31 0
40 4252U FUSIDIC ACID 2% CR (CHC/ATB) 15G A 2.75 2% 2 2022-04-01 2024-03-31 0
41 4252U FUSIDIC ACID 2% CR (CHC) 15G A 3.5882 2% 2 2024-04-01 2026-03-31 0
41 4252V FUSIDIC ACID 2% CR (FSB) 15G A 2.4465 2% 2 2024-04-01 2026-03-31 0
40 4252W FUSIFEN 2% CR (FUR/ATB) FUSIDIC ACID 15G A 2.91 2% 2 2022-04-01 2024-03-31 0
41 4252X FUSIBACT 2% CR (LDP) FUSIDIC ACID (C) 15G C 6.4152 2% 2 2024-04-01 2026-03-31 0
41 4253AK FUSIDIC ACID 2% OINT (KWA) 15G A 3.561 2% 2 2024-04-01 2026-03-31 0
40 4253AQ FUSIDIC ACID 2% OINT (CHC/ATB) 15G A 2.77 2% 2 2022-04-01 2024-03-31 0
40 4253AT FUSIFEN 2% OINT (FUR/ATB) FUSIDIC ACID 15G A 2.72 2% 2 2022-04-01 2024-03-31 0