Displaying 1 - 7 of 7
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 B4217 FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI 30'S A 2.0532 10MG 30 2024-04-01 2024-06-30 6
41 B4217 FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI 30'S B 2.0533 10MG 30 2024-08-16 2026-03-31 6
41 B4218 FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN 30'S A 2.0532 5MG 30 2024-04-01 2024-04-24 6
41 B4218 FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN 30'S B 2.0533 5MG 30 2024-08-16 2026-03-31 6
41 B421A DAPAGLIFLOZIN 10MG TAB (KWA) 28'S A 0.2777 10MG 30 2024-04-01 2026-03-31 6
41 B421H DAPAGLIFLOZIN 5MG TAB (MCP) 3X10 A 0.3443 5MG 30 2024-04-01 2024-10-31 6
41 B421M DAPAGLIFLOZIN 5MG TAB (MCP) 100'S A 0.3444 5MG 30 2024-10-29 2026-03-31 6