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 0231B SYMBICORT RAPIHALER 80MCG | 4.5MCG INHR (AZN/COL) BUDESONIDE | FORMOTEROL (R) 120 DOSES A 35.23 80MCG|4.5MCG 1 2022-04-01 2024-03-31 6
41 0231B SYMBICORT RAPIHALER 80MCG|4.5MCG INHR (AZN) BUDESONIDE|FORMO 120 DOSES A 35.2295 80MCG|4.5MCG 1 2024-04-01 2026-03-31 6