Displaying 1 - 9 of 9
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 3653BJ AVAMYS 27.5MCG NASAL SP (GSK/COL) FLUTICASONE 120 DOSES C 25.14 27.5MCG 0 2022-04-01 2024-03-31 0
41 3653BJ AVAMYS 27.5MCG NASAL SP (GSK) FLUTICASON (C) 120 DOSES C 26.6668 27.5MCG 1 2024-04-01 2026-03-31 6
40 3653CE FLUTICASONE 27.5MCG NASAL SP (CIR/AHI) 200 DOSES A 14.68 27.5MCG 1 2022-04-01 2022-09-30 6
41 3653CE FLUTICASONE 27.5MCG NASAL SP (CIR) 200 DOSES A 14.1353 27.5MCG 1 2024-04-01 2026-03-31 6
40 3653CF FLUTICASONE 50MCG NASAL SP (CIR/AHI) 200 DOSES A 14.08 50MCG 1 2022-04-01 2024-03-31 6
41 3653CF FLUTICASONE 50MCG NASAL SP (CIR) 200 DOSES A 15.277 50MCG 1 2024-04-01 2026-03-31 6
40 3653CS FLUTICASONE 27.5MCG NASAL SP (ARP/AHI) 120 DOSES A 12.99 27.5MCG 1 2022-04-01 2024-03-31 6
40 3653P FLIXONASE 50MCG NASAL SP (GSK/COL) FLUTICASON 120 DOSES A 12.91 50MCG 1 2022-04-01 2024-03-31 6
41 3653P FLIXONASE 50MCG NASAL SP (GSK) FLUTICASO 120 DOSES A 13.6732 50MCG 1 2024-04-01 2024-07-25 6