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 0884BD PULMICORT 0.25MG/ML RESP SOL (AZN/COL) BUDESO 20X2ML A 2.04 0.25MG/ML 20 2022-04-13 2024-03-31 Add to Contract as Cat A 6
40 0884BE PULMICORT 0.5MG/ML RESP SOL (AZN/COL) BUDESON 20X2ML A 2.31 0.5MG/ML 20 2022-04-13 2024-03-31 Add to Contract as Cat A 6
40 2641CE BUDESONIDE 200MCG INHR (MCP/AHI) 200 DOSES A 6.99 200MCG 1 2022-04-01 2024-03-31 6
41 2641CE BUDESONIDE 200MCG INHR (MCP) 200 DOSES A 9.1336 200MCG 1 2024-04-01 2026-03-31 6