Displaying 1 - 6 of 6
  • 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 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE/STO) TIOTRO TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 111.29 111.29 INHALER 0 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE) TIOTR (BQ) TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 121.59 121.5906 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2024-04-01 2026-03-31 ORAL INHALATION 6 ANTICHOLINERGIC AGENTS (RESPIRATORY)
42 09116 SPIRIVA RESPIMAT 2.5MCG INHR (BOE) TIOTR TIOTROPIUM SPIRIVA RESPIMAT 60 DOSES BQ 121.59 121.59 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2026-04-01 ORAL INHALATION 0 ANTICHOLINERGIC AGENTS (RESPIRATORY)
40 09118 SPIOLTO RESPIMAT 2.5/2.5MCG INHR (BOE/STO) TI OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 111.29 111.29 INHALER 1 INHR BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2022-04-01 2024-03-31 ORAL INHALATION 6 RESPIRATORY TRACT AGENTS
41 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP (BQ) OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 121.59 121.5906 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2024-04-01 2026-03-31 ORAL INHALATION 6 ANTICHOLINERGIC AGENTS (RESPIRATORY)
42 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP OLODATEROL|TIOTROPIUM SPIOLTO RESPIMAT 60 DOSES BQ 121.59 121.59 INHR 1 BOX BOE BOEHRINGER INGELHEIM STO BRYDEN STOKES LTD 481208 ANTICHOLINERGIC AGENTS (RESPIRATORY) 2026-04-01 ORAL INHALATION 0 ANTICHOLINERGIC AGENTS (RESPIRATORY)