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 02316 DULERA 5MCG | 100MCG INHR (MSD/STO) FORMOTEROL | MOMETASONE 120 DOSES B 56.68 5MCG|100MCG 1 2022-04-01 2024-03-31 6
41 02316 DULERA 5MCG|100MCG INHR (MSD) FORMOTEROL|MOMETASONE (C) 120 DOSES C 58.3896 5MCG|100MCG 1 2024-04-01 2026-03-31 6
40 02326 DULERA 200MCG/5MCG INHR (MSD/STO) MOMETASONE/ 120 DOSES B 59.26 5MCG|200MCG 1 2022-04-01 2024-03-31 6
41 02326 DULERA 200MCG/5MCG INHR (MSD) MOMETASONE (B) 120 DOSES B 61.0264 5MCG|200MCG 1 2024-04-01 2026-03-31 6