Displaying 1 - 14 of 14
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 26416 FLIXOTIDE 50MCG INHR (GSK/COL) FLUTICASONE 120 DOSES A 21.67 50MCG 1 2022-04-01 2024-03-31 6
41 26416 FLIXOTIDE 50MCG INHR (GSK) FLUTICASONE 120 DOSES A 23.8397 50MCG 1 2024-04-01 2026-03-31 6
42 26416 FLIXOTIDE 50MCG INHR (GSK) FLUTICASONE 120 DOSES C 25.04 50MCG 1 2026-04-01 No No 6
40 2641AB FLIXOTIDE 250MCG INHR (GSK/COL) FLUTICASONE 60 DOSES A 26.72 250MCG 1 2022-04-01 2024-03-31 6
41 2641AB FLIXOTIDE 250MCG INHR (GSK) FLUTICASONE 60 DOSES A 29.3851 250MCG 1 2024-04-01 2026-03-31 6
42 2641AB FLIXOTIDE 250MCG INHR (GSK) FLUTICASONE 60 DOSES C 30.85 250MCG 1 2026-04-01 No No 6
42 2641CS APO-FLUTICASONE 250MCG INHR (APO) 120 DOSES A 14.79 250MCG 1 2026-04-01 No No 6
42 2641CT APO-FLUTICASONE 125MCG INHR (APO) 120 DOSES A 14.00 125MCG 1 2026-04-01 No No 6
42 2641CX FLUTICASONE 125MCG INHR (CHC) 120 DOSES A 8.21 125MCG 1 2026-04-01 No No Add to Contract as Cat A 6
42 2641CY FLUTICASONE 250MCG INHR (CHC) 120 DOSES A 9.27 250MCG 1 2026-04-01 No No Add to Contract as Cat A 6
42 2641CZ FLUTICASONE 50MCG INHR (CHC) 120 DOSES A 7.50 50MCG 1 2026-04-01 No No Add to Contract as Cat A 6
40 2641U FLIXOTIDE 125MCG INHR (GSK/COL) FLUTICASONE 60 DOSES A 17.21 125MCG 1 2022-04-01 2024-03-31 6
41 2641U FLIXOTIDE 125MCG INHR (GSK) FLUTICASONE 60 DOSES A 18.9467 125MCG 1 2024-04-01 2026-03-31 6
42 2641U FLIXOTIDE 125MCG INHR (GSK) FLUTICASONE 60 DOSES C 19.90 125MCG 1 2026-04-01 No No 6