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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 02316 DULERA 5MCG | 100MCG INHR (MSD/STO) FORMOTEROL | MOMETASONE FORMOTEROL|MOMETASONE DULERA 120 DOSES B 56.68 56.68 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02316 DULERA 5MCG|100MCG INHR (MSD) FORMOTEROL|MOMETASONE (C) FORMOTEROL|MOMETASONE DULERA 120 DOSES C 58.39 58.3896 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS
40 02326 DULERA 200MCG/5MCG INHR (MSD/STO) MOMETASONE/ FORMOTEROL|MOMETASONE DULERA 120 DOSES B 59.26 59.26 INHALER 1 INHR MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD 4892 RESPIRATORY AGENTS MISCELLANEOUS 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 02326 DULERA 200MCG/5MCG INHR (MSD) MOMETASONE (B) FORMOTEROL|MOMETASONE DULERA 120 DOSES B 61.03 61.0264 INHR 1 BOX MSD MERCK SHARP & DOHME (I.A.) CORP STO BRYDEN STOKES LTD B 4892 RESPIRATORY AGENTS MISCELLANEOUS 2024-04-01 2026-03-31 ORAL INHALATION 6 RESPIRATORY AGENTS MISCELLANEOUS