Displaying 1 - 10 of 10
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
41 B4612 XIGDUO 5MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S A 1.312 5MG|1G 30 2024-04-01 2024-06-30 6
41 B4612 XIGDUO 5MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S B 1.312 5MG|1G 30 2024-08-16 2026-03-31 6
42 B4612 XIGDUO 5MG|1G XR TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S C 1.36 5MG|1G 30 2026-04-01 No No 0
41 B4613 DAPAGLIFLOZIN|METFORMIN 5MG|1G TAB (KWA) 30'S A 0.2773 5MG|1G 30 2024-04-01 2026-03-31 6
42 B4616 DAPAGLIFLOZIN|METFORMIN 5MG|1G TAB (ZHL) 3X10 A 0.21 5MG|1G 30 2026-04-01 No No 6
41 B4622 XIGDUO 10MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S A 2.0532 10MG|1G 30 2024-04-01 2024-06-30 6
41 B4622 XIGDUO 10MG|1G TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S B 2.0533 10MG|1G 30 2024-08-16 2026-03-31 6
42 B4622 XIGDUO 10MG|1G XR TAB (AZN) DAPAGLIFLOZIN|METFORMIN 30'S C 2.05 10MG|1G 30 2026-04-01 No No 0
41 B4625 DAPAGLIFLOZIN|METFORMIN 10MG|1G TAB (KWA) 30'S A 0.3325 10MG|1G 30 2024-04-01 2026-03-31 6
42 B462D DAPAGLIFLOZIN|METFORMIN 10MG|1G XR TAB (ZHL) 3X10 A 0.27 10MG|1G 30 2026-04-01 No No 6