Displaying 1 - 2 of 2
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 A4021 COMBIVENT 0.2MG/ML | 1MG/ML RESP SOL (BOE/STO) IPRATROPIUM | SALBUTAMOL 20X2.5ML A 3.36 0.2MG/ML|1MG/ML 20 2022-04-01 2024-03-31 6
41 A4021 COMBIVENT 0.2MG/ML|1MG/ML RESP SOL (BOE) IPRATROPIUM|SALBUTA 20X2.5ML A 3.4577 0.2MG/ML|1MG/ML 20 2024-04-01 2026-03-31 6