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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
41 6691M ANGELIQ 1MG E/2MG D TAB (BSP) ESTRADIOL/ (C) DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 26.61 26.6124 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 0 ESTROGENS
42 6691M ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 26.61 26.61 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. AHI ARMSTRONG HEALTHCARE INC 681604 ESTROGENS 2026-04-01 ORAL 0 ESTROGENS
41 6691N ANGELIQ 1MG E/2MG D TAB (BSP) ESTRADIOL/ (C) DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 26.61 26.6124 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. COL COLLINS LTD 681604 ESTROGENS 2024-04-01 2026-03-31 ORAL 0 ESTROGENS
42 6691N ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL DROSPIRENONE|ESTRADIOL ANGELIQ 28'S C 24.22 24.22 PACK 0 BOX BSP BAYER SCHERING PHARMA AG. COL AVENTA BARBADOS 681604 ESTROGENS 2026-04-01 ORAL 0 ESTROGENS