Contract Changes [B4217 , 2024-08-16]

Contract Number	41
Brand Code	B4217
Drug	FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI
LAgent Code	COL
Package Size	30'S
Formulary Category	B
Package Price	61.6
Protocol Monthly Max	30
Drug Contract Start Date	2024-08-16
Drug Contract End Date	2026-03-31
Contract Changed
Change Date	2024-08-16