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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
40 6691AD QLAIRA TAB (BSP/COL) ESTRADIOL/DIENOGEST DIENOGEST|ESTRADIOL QLAIRA 28'S C 27.18 0.97 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 6691AD QLAIRA TAB (BSP) ESTRADIOL/DIENOGEST (C) DIENOGEST|ESTRADIOL QLAIRA 28'S C 27.18 0.9708 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 0 ESTROGENS
42 6691AD QLAIRA 3MG|3MG TAB (BSP) DIENOGEST (C) DIENOGEST|ESTRADIOL QLAIRA 28'S C 22.89 0.82 TAB 0 BLIS BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 681604 ESTROGENS 2026-04-01 ORAL 0 ESTROGENS
40 6691AE QLAIRA TAB (BSP/AHI) ESTRADIOL/DIENOGEST DIENOGEST|ESTRADIOL QLAIRA 28'S C 27.18 0.97 TABLET 0 TAB BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2022-04-01 2024-03-31 Oral 0 HORMONES AND SYNTHETIC SUBSTITUTES
41 6691AE QLAIRA TAB (BSP) ESTRADIOL/DIENOGEST (C) DIENOGEST|ESTRADIOL QLAIRA 28'S C 27.18 0.9708 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 0 ESTROGENS
42 6691AE QLAIRA 3MG|3MG TAB (BSP) DIENOGEST|ESTRADIOL DIENOGEST|ESTRADIOL QLAIRA 28'S C 25.14 0.90 TAB 0 BLIS BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2026-04-01 ORAL 0 ESTROGENS
41 6691AK VISANNE 2MG TAB (BSP) DIENOGEST (C) DIENOGEST VISANNE 28'S C 108.73 3.8833 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 6 CONTRACEPTIVES
42 6691AK VISANNE 2MG TAB (BSP) DIENOGEST DIENOGEST VISANNE 28'S C 92.42 3.30 TAB 0 BLIS BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 6812 CONTRACEPTIVES 2026-04-01 ORAL 0 CONTRACEPTIVES
41 6691AL VISANNE 2MG TAB (BSP) DIENOGEST (C) DIENOGEST VISANNE 28'S C 108.73 3.8833 TAB 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 6812 CONTRACEPTIVES 2024-04-01 2026-03-31 ORAL 0 CONTRACEPTIVES
42 6691AL VISANNE 2MG TAB (BSP) DIENOGEST DIENOGEST VISANNE 28'S C 84.10 3.00 TAB 0 BLIS BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 6812 CONTRACEPTIVES 2026-04-01 ORAL 0 CONTRACEPTIVES