Displaying 1 - 4 of 4
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 0231C SYMBICORT TURBU 80MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL 60 DOSES A 24.27 80MCG|4.5MCG 1 2022-04-01 2024-03-31 6
41 0231C SYMBICORT TURBU 80MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMOTERO 60 DOSES A 24.2746 80MCG|4.5MCG 1 2024-04-01 2026-03-31 6
40 02335 SYMBICORT TURBU 320MCG | 9MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL 60 DOSES A 52.19 320MCG|9MCG 1 2022-04-01 2024-03-31 6
41 02335 SYMBICORT TURBU 320MCG|9MCG INHR (AZN) BUDESONIDE|FORMOTEROL 60 DOSES A 52.1918 320MCG|9MCG 1 2024-04-01 2026-03-31 6