Product Details
Advair 125
Salmeterol Xinafoate + Fluticasone Propionate25 mcg + 125 mcg/Metered-Dose
Inhalation Aerosol
120-Dose Pack
DIN/PIN/NPN
02245126
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2003-01-30
Unit Price
128.42
Amount MOH Pays
128.42
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. |