Drugs available on Contract - [QLAIRA 3MG|3MG TAB (BSP) DIENOGEST|ESTRADIOL], []

Contract Number	42
Brand Code	6691AE
Brand Name	QLAIRA 3MG\|3MG TAB (BSP) DIENOGEST\|ESTRADIOL
Active Ingredient	DIENOGEST\|ESTRADIOL
Trade Name	QLAIRA
Package Size	28'S
Formulary Category	C
Pkg Price	25.14
Unit Price	0.90
Strength	3MG\|3MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	0
Package Description	BLIS
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	2026-04-01
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	681604
Therapeutic Desc	ESTROGENS
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	ESTROGENS
Amend Date