Displaying 1 - 10 of 10
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 5231AD DAKTARIN 2% CR (JAC/STO) MICONAZOLE 30G C 15.41 2% 0 2022-04-01 2022-05-24 Delete from contract 0
41 5231Z MICAZOLE 2% CR (GPC) MICONAZOLE 15G A 1.7397 2% 2 2024-04-01 2026-03-31 0
40 5231ZJ MICOSPEC 2% CR (CAR/COL) MICONAZOLE 15G C 3.64 2%/G 0 2022-04-01 2024-03-31 0
41 5231ZJ MICOSPEC 2% CR (CAR) MICONAZOLE (C) 15G C 3.6697 2% 2 2024-04-01 2026-03-31 0
40 5231ZK MICONAZOLE 2% CR (CIP/AHI) 15G A 2.12 2% 2 2022-04-01 2024-03-31 0
40 5233Q MICOSPEC 2% PWDR (CAR/COL) MICONAZOLE 15G A 4.89 2% 2 2022-04-01 2024-03-31 0
41 5233Q MICOSPEC 2% POWDER (CAR) MICONAZOLE 15G A 5.1104 2% 2 2024-04-01 2026-03-31 0
40 52352 DAKTARIN 2% GEL (JAC/STO) MICONAZOLE 78G BQ 28.27 2% 0 2022-04-01 2022-05-24 Delete from contract 0
41 52353 MICOGEL ORAL 2% GEL (CIP) MICONAZOLE 15G B 5.3551 2% 2 2024-04-01 2026-03-31 6
41 52354 MICOGEL 2% GEL (ARP) MICONAZOLE 15G B 5.36 2% 2 2024-04-01 2026-03-31 6