Displaying 1 - 3 of 3
  • Print
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 79913 BEROTEC N 100MCG INHR (BOE/AHI) FENOTEROL FENOTEROL BEROTEC N 200 DOSES A 31.80 31.80 INHALER 1 INHR BOE BOEHRINGER INGELHEIM AHI ARMSTRONG HEALTHCARE INC B 48120412 SELECTIVE BETA2 ADRENERGIC AGONIST (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 79913 BEROTEC N 100MCG INHR (BOE) FENOTEROL FENOTEROL BEROTEC N 200 DOSES A 33.3 33.3 INHR 1 BOX BOE BOEHRINGER INGELHEIM AHI ARMSTRONG HEALTHCARE INC B 48120412 SELECTIVE BETA2 ADRENERGIC AGONIST (RESPIRATORY) 2024-11-11 2026-03-31 ORAL INHALATION 6 SELECTIVE BETA2 ADRENERGIC AGONIST (RESPIRA 2024-11-11
42 79913 BEROTEC N 100MCG INHR (BOE) FENOTEROL FENOTEROL BEROTEC N 200 DOSES A 33.30 33.30 INHR 1 BOX BOE BOEHRINGER INGELHEIM AHI ARMSTRONG HEALTHCARE INC B 48120412 SELECTIVE BETA2 ADRENERGIC AGONIST (RESPIRATORY) 2026-04-01 Add to Contract as Cat A ORAL INHALATION 6 SELECTIVE BETA2 ADRENERGIC AGONIST (RESPIRA 2026-03-18