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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 2791D OVESTIN 1MG VAG CR (ASP/STO) ESTRIOL ESTRIOL OVESTIN 15G A 41.59 41.59 VAGINAL CREA 1 TUBE ASP ASTRAPIN, PHARMA GMBH & CO. HG STO BRYDEN STOKES LTD 681604 ESTROGENS 2022-04-01 2024-03-31 Add to Contract as Cat A Vaginal 6 HORMONES AND SYNTHETIC SUBSTITUTES 2021-12-06
41 2791D OVESTIN 1MG VAG CR (ASG) ESTRIOL ESTRIOL OVESTIN 15G A 42 41.9981 TUBE 1 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 681604 ESTROGENS 2024-04-01 2026-03-31 Vaginal 6 ESTROGENS
42 2791D OVESTIN 1MG VAG CR (ASG) ESTRIOL ESTRIOL OVESTIN 15G A 45.80 45.80 TUBE 1 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 681604 ESTROGENS 2026-04-01 VAGINAL 6 ESTROGENS
41 27921 OVESTIN 0.5MG OV (ASG) ESTRIOL ESTRIOL OVESTIN 15'S A 41.9981 41.9981 PACK 1 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 681604 ESTROGENS 2024-04-01 2026-03-31 VAGINAL 6 ESTROGENS
42 27921 OVESTIN 0.5MG OV (ASG) ESTRIOL ESTRIOL OVESTIN 15'S A 45.80 3.05 OV 15 BOX ASG ASPEN OSD (GLOBAL) STO BRYDEN STOKES LTD 681604 ESTROGENS 2026-04-01 Amend Protocol Quantity VAGINAL 6 ESTROGENS 2026-04-23