Displaying 1 - 2 of 2
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 0232F SYMBICORT TURBU 160MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (120) 120 DOSES A 44.31 160MCG|4.5MCG 1 2022-04-01 2024-03-31 6
41 0232F SYMBICORT TURBU 160MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMOTER 120 DOSES A 44.3087 160MCG|4.5MCG 1 2024-04-01 2026-03-31 6