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 4253AD BACTROBAN 2% OINT (GSK/COL) MUPIROCIN 15G C 11.91 2% 0 2022-04-01 2024-03-31 0
41 4253AD BACTROBAN 2% OINT (GSK) MUPIROCIN (C) 15G C 13.1023 2% 2 2024-04-01 2026-03-31 6
42 4253AD BACTROBAN 2% OINT (GSK) MUPIROCIN 15G C 13.75 2% 2 2026-04-01 No No 6
40 4253AR DERMOCIN 2% OINT (ARP/AHI) MUPIROCIN 10G BQ 5.16 2% 0 2022-04-01 2024-03-31 6
41 4253AR DERMOCIN 2% OINT (ARP) MUPIROCIN (BQ) 10G BQ 5.1648 2% 2 2024-04-01 2026-03-31 6
40 4253AV SUPIROCIN 2% OINT (GLP/ATB) MUPIROCIN 15G BQ 5.44 2% 0 2022-04-01 2024-03-31 Change Local Agent 6
42 4253AW SUPIROCIN 2% OINT (GLP) MUPIROCIN 15G BQ 4.89 2% 2 2026-04-01 No No 0
42 4253AX MUPIROCIN 2% OINT (CHC) 15G BQ 2.56 2% 2 2026-04-01 No No Add to Contract 0
42 4253BA SUPIROCIN 2% OINT (GLP) MUPIROCIN 15G BQ 4.89 2% 2 2026-04-01 No No 0
40 4253P SUPIROCIN 2% OINT (GLP/ALI) MUPIROCIN 15G BQ 5.44 2% 0 2022-04-01 2022-03-22 Delete from contract 6