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 A3926 RELVAR ELLIPTA 100MCG | 25MCG INHR (GSK/COL) FL 30 DOSES A 41.67 100MCG|25MCG 1 2022-04-01 2024-03-31 6
41 A3926 RELVAR ELLIPTA 100MCG|25MCG INHR (GSK) F 30 DOSES A 43.3301 100MCG|25MCG 1 2024-04-01 2026-03-31 6
40 A3969 RELVAR ELLIPTA 200MCG | 25MCG INHR (GSK/COL) FL 30 DOSES A 44.25 200MCG|25MCG 1 2022-04-01 2024-03-31 6
41 A3969 RELVAR ELLIPTA 200MCG|25MCG INHR (GSK) F 30 DOSES A 46.0212 200MCG|25MCG 1 2024-04-01 2026-03-31 6