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| Contract Number | Brand Code | Brand Name | Package Size | Formulary Category | Unit Price | Strength | Max. Reimbursable / Month | Drug Contract Start Date | Drug Contract End Date | Restrict To Ophthalmologist | Restrict To Pulmonologist | Status Description | Max Repeats | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 40 | 5581A | HISTAL EXPECTORANT 96MG/ML | 2.5MG/ML SYR (CAR/COL) AMMONIUM CHLORIDE | CHLORPHE More ... | 2 LITRES | B | 0.03 | 96MG/ML|2.5MG/ML | 0 | 2022-05-06 | 2024-03-31 | Add to Contract as Cat B | 0 | |||
| 41 | 5581A | HISTAL EXPECTORANT 96MG/ML|2.5MG/ML SYR (CAR) AMMONIUM CHLOR (B) | 2 LITRES | B | 0.0313 | 96MG/ML|2.5MG/ML | 0 | 2024-04-01 | 2026-03-31 | 0 | ||||