Displaying 1 - 20 of 24
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 A3911 SERETIDE DISKUS 250MCG | 50MCG INHR (GSK/COL) F 60 DOSES C 55.45 250MCG|50MCG 0 2022-04-01 2024-03-31 0
41 A3911 SERETIDE DISKUS 250MCG|50MCG INHR (GSK) 60 DOSES A 58.7973 250MCG|50MCG 1 2024-04-01 2026-03-31 6
40 A3912 SEROFLO CIPHALER 250MCG | 50M INHR (CIP/AHI) FLUTICASONE | SALMETEROL 60 DOSES A 44.25 250MCG|50MCG 1 2022-04-01 2024-03-31 6
40 A3931 SERETIDE MDI 125/25 INHR (GSK/COL) FLUTICASON 120 DOSES C 56.57 125MCG|25MCG 0 2022-04-01 2024-03-31 0
41 A3931 SERETIDE MDI 125MCG|25MCG INHR (GSK) FLUTICASONE|SALMETEROL (C) 120 DOSES C 62.2224 125MCG|25MCG 1 2024-04-01 2026-03-31 6
40 A3933 FLUTICASONE | SALMETEROL 125MCG | 25MCG INHR (CIP/AHI) 120 DOSES A 27.65 125MCG|25MCG 1 2022-04-01 2024-03-31 6
41 A3933 FLUTICASONE|SALMETEROL 125MCG|25MCG INHR (CIP) 120 DOSES A 27.6454 125MCG|25MCG 1 2024-04-01 2026-03-31 6
40 A3937 COMBIWAVE 125/25 INHR (GLP/ALI) FLUTICASONE/S 120 DOSES C 27.18 125MCG|25MCG 0 2022-04-01 2022-03-22 Delete from contract 0
40 A3939 AROFLO 125MCG | 25MCG INHR (ARP/AHI) FLUTICASON 120 DOSES A 21.67 125MCG|25MCG 1 2022-04-01 2022-06-30 6
40 A393D COMBIWAVE 125MCG | 25M INHR (GLP/ATB) FLUTICASONE | SALMETEROL 120 DOSES C 27.18 125MCG|25MCG 0 2022-04-01 2024-03-31 Change Local Agent 0
40 A3941 SERETIDE MDI 50/25 INHR (GSK/COL) FLUTICASONE 120 DOSES C 48.20 50MCG|25MCG 0 2022-04-01 2024-03-31 0
41 A3941 SERETIDE MDI 50/25 INH (GSK) FLUTICASONE 120 DOSES A 53.0073 50MCG|25MCG 1 2024-04-01 2026-03-31 6
40 A3942 FLUTICASONE | SALMETEROL 50MCG | 25MCG INHR (CIP/AHI) 120 DOSES A 27.10 50MCG|25MCG 1 2022-04-01 2024-03-31 6
40 A3951 SERETIDE DISKUS 500MCG | 50MCG INHR (GSK/COL) F 60 DOSES A 60.97 500MCG|50MCG 0 2022-04-01 2024-03-31 CHANGE FROM CAT C -CAT A 0
41 A3951 SERETIDE DISKUS 500MCG|50MCG INHR (GSK) 60 DOSES A 64.0981 500MCG|50MCG 1 2024-04-01 2026-03-31 6
40 A3954 FLUTICASONE | SALMETEROL 500MCG | 50MCG INHR (CIP/AHI) 60 DOSES A 53.58 500MCG|50MCG 1 2022-04-01 2024-03-31 6
40 A3961 SERETIDE MDI 250MCG | 25MCG INHR (GSK/COL) FLUTICASONE | SALMETEROL 120 DOSES C 62.17 250MCG|25MCG 0 2022-04-01 2024-03-31 0
41 A3961 SERETIDE MDI 250MCG|25MCG INHR (GSK) FLUTICASONE|SALMETEROL (C) 120 DOSES C 68.393 250MCG|25MCG 1 2024-04-01 2026-03-31 6
40 A3965 COMBIWAVE 250MCG | 25MCG INHR (GLP/ALI) FLUTICASONE | SALMETEROL 150 DOSES C 32.62 250MCG|25MCG 0 2022-04-01 2022-03-22 Delete from contract 0
40 A3966 SEROFLO 250MCG | 25MCG INHR (CIP/AHI) FLUTICASONE | SALMETEROL 120 DOSES A 39.96 250MCG|25MCG 1 2022-04-01 2024-03-31 6