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 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
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
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