Displaying 1 - 6 of 6
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 0012AB ALLEGRA 120MG TAB (SFA/COL) FEXOFENADINE 10'S C 0.95 120MG 0 2022-04-01 2024-03-31 0
40 0012AQ ALLEGRA 180MG TAB (SFA/COL) FEXOFENADINE 10'S C 1.02 180MG 0 2022-04-01 2024-03-31 0
41 0012FR AXOFEN 120MG TAB (ARP) FEXOFENADINE (C) 30'S C 0.7756 120MG 0 2024-04-01 2026-03-31 0
42 0012FY FEXOSTAL 180MG TAB (STL) FEXOFENADINE 10X10 C 0.10 180MG 0 2026-04-01 No No 0
42 0012GR FEEGRA 120MG SR TAB (JLP) FEXOFENADINE 10X10 C 0.27 120MG 0 2026-04-01 No No 0
40 0013G ALLEGRA 6MG/ML SUSP (SFA/COL) FEXOFENADINE 150ML C 0.09 6MG/ML 0 2022-04-01 2024-03-31 0