Drugs available on Contract - [QLAIRA TAB (BSP/AHI) ESTRADIOL/DIENOGEST], []

Contract Number	40
Brand Code	6691AE
Brand Name	QLAIRA TAB (BSP/AHI) ESTRADIOL/DIENOGEST
Active Ingredient	DIENOGEST\|ESTRADIOL
Trade Name	QLAIRA
Package Size	28'S
Formulary Category	C
Pkg Price	27.18
Unit Price	0.97
Strength	3MG\|3MG
Unit Description	TABLET
Max. Reimbursable Quantity / Month	0
Package Description	TAB
Manufacturer Code	BSP
Manufacturer Name	BAYER SCHERING PHARMA AG.
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	681604
Therapeutic Desc	ESTROGENS
Status Description
Default Route	Oral
Max Repeats	0
Therapeutic Head	HORMONES AND SYNTHETIC SUBSTITUTES
Amend Date