Displaying 1 - 12 of 12
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 3301AJ FURASONE 0.1% CR (CAR/COL) MOMETASONE 15G A 5.16 0.1% 2 2022-04-01 2024-03-31 0
41 3301AJ FURASONE 0.1% CR (CAR) MOMETASONE 15G A 6.1978 0.1% 2 2024-04-01 2026-03-31 0
40 3301AX MOMETASONE 0.1% CR (KWA/ATB) 15G A 4.49 0.1% 2 2022-04-01 2024-03-31 0
40 3301BC ELOCOM 0.1% CR (MSD/STO) MOMETASONE 15G C 10.11 0.1% 0 2022-04-01 2024-03-31 0
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE 15G A 10.22 0.1% 2 2024-04-01 2024-07-18 0
41 3301BC ELOCOM 0.1% CR (MSD) MOMETASONE (C) 15G C 10.2209 0.1% 2 2024-07-19 2026-03-31 0
41 3301BK TROSONE 0.1% CR (AUR) MOMETASONE 15G A 5.0561 0.1% 2 2024-04-01 2026-03-31 0
40 3302BC ELOCON 0.1% OINT (MSD/STO) MOMETASONE 15G C 11.93 0.1% 0 2022-04-01 2024-03-31 0
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE 15G A 12.0422 0.1% 2 2024-04-01 2024-07-18 0
41 3302BC ELOCON 0.1% OINT (MSD) MOMETASONE (C) 15G C 12.04 0.1% 2 2024-07-19 2026-03-31 0
40 3302Z FURASONE 0.1% OINT (CAR/COL) MOMETASONE 15G A 5.16 0.1% 2 2022-04-01 2024-03-31 0
41 3302Z FURASONE 0.1% OINT (CAR) MOMETASONE 15G A 6.1978 0.1% 2 2024-04-01 2026-03-31 0