Displaying 1 - 3 of 3
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 09118 SPIOLTO RESPIMAT 2.5/2.5MCG INHR (BOE/STO) TI 60 DOSES BQ 111.29 2.5MCG|2.5MCG 1 2022-04-01 2024-03-31 6
41 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP (BQ) 60 DOSES BQ 121.5906 2.5MCG|2.5MCG 1 2024-04-01 2026-03-31 Yes 6
42 09118 SPIOLTO RESPIMAT 2.5MCG|2.5MCG INHR (BOE) OLODATEROL|TIOTROP 60 DOSES BQ 121.59 2.5MCG|2.5MCG 1 2026-04-01 No No 0