Product Details
Advair 250
Salmeterol Xinafoate + Fluticasone Propionate25 mcg + 250 mcg/Metered-Dose
Inhalation Aerosol
120-Dose Pack
DIN/PIN/NPN
02245127
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2003-01-30
Unit Price
182.31
Amount MOH Pays
182.31
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AK06
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 330 | Indefinite | For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms. |