Drugs available on Contract - [ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL], []

Contract Number	42
Brand Code	6691M
Brand Name	ANGELIQ 2MG\|1MG TAB (BSP) DROSPIRENONE\|ESTRADIOL
Active Ingredient	DROSPIRENONE\|ESTRADIOL
Trade Name	ANGELIQ
Package Size	28'S
Formulary Category	C
Pkg Price	26.61
Unit Price	26.61
Strength	2MG\|1MG
Unit Description	PACK
Max. Reimbursable Quantity / Month	0
Package Description	BOX
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	1
Dentist Allowed	N
Therapeutic Code	681604
Therapeutic Desc	ESTROGENS
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	ESTROGENS
Amend Date