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| Contract Number | Brand Code | Brand Name | Active Ingredient | Trade Name | Package Size | Formulary Category | Pkg Price | Unit Price | Unit Description | Max. Reimbursable Quantity / Month | Package Description | Manufacturer Code | Manufacturer Name | Agent Code | Agent Name | Benefit | Therapeutic Code | Therapeutic Desc | Drug Contract Start Date | Drug Contract End Date | Status Description | Default Route | Max Repeats | Therapeutic Head | Amend Date | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 40 | 0232E | SYMBICORT RAPIHALER 160MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (120 More ... | BUDESONIDE|FORMOTEROL (120 R) | SYMBICORT RAPIHALER | 120 DOSES | A | 37.68 | 37.68 | INHALER | 1 | INHR | AZN | ASTRAZENECA AB | COL | COLLINS LTD | B | 4892 | RESPIRATORY AGENTS MISCELLANEOUS | 2022-04-01 | 2024-03-31 | ORAL INHALATION | 6 | RESPIRATORY TRACT AGENTS | ||||
| 41 | 0232E | SYMBICORT RAPIHALER 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORM | BUDESONIDE|FORMOTEROL (120 R) | SYMBICORT RAPIHALER | 120 DOSES | A | 37.68 | 37.676 | INHR | 1 | BOX | AZN | ASTRAZENECA AB | COL | COLLINS LTD | B | 4892 | RESPIRATORY AGENTS MISCELLANEOUS | 2024-04-01 | 2026-03-31 | ORAL INHALATION | 6 | RESPIRATORY AGENTS MISCELLANEOUS | ||||
| 42 | 0232E | SYMBICORT RAPIHALER 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORM | BUDESONIDE|FORMOTEROL (120 R) | SYMBICORT RAPIHALER | 120 DOSES | A | 37.68 | 37.68 | INHR | 1 | BOX | AZN | ASTRAZENECA AB | COL | AVENTA BARBADOS | B | 4892 | RESPIRATORY AGENTS MISCELLANEOUS | 2026-04-01 | ORAL INHALATION | 6 | RESPIRATORY AGENTS MISCELLANEOUS | |||||