Displaying 4681 - 4700 of 5993
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
41 7621AN YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL (C) 28'S C 19.0283 3MG|0.02MG 0 2024-04-01 2026-03-31 0
42 7621AN YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL 28'S C 19.03 3MG|0.02MG 0 2026-04-01 No No 0
40 7621AW ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL | LEVONORGESTREL 21'S C 13.59 30MCG|150MCG 0 2022-04-01 2024-03-31 0
40 7621AX ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL | LEVONORGESTRE 28'S C 13.59 30MCG|150MCG 0 2022-04-01 2024-03-31 0
40 7621AZ CICLOTAB 20MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE 21'S C 15.98 20MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621AZ CICLOTAB 20MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) 21'S C 15.98 20MCG|75MCG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BB CICLOTAB 30MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE 21'S C 15.98 30MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621BB CICLOTAB 30MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) 21'S C 15.98 30MCG|75MCG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BC DIXI 35 2MG | 35MCG TAB (ABB/PHA) CYPROTERONE | ETHINYL ESTRADIOL 21'S C 0.57 2MG|35MCG 0 2022-04-01 2024-03-31 0
40 7621BC DIXI 35 2MG C/35MCG E TAB (ABB/PHA) CYPROTERO (C) 21'S C 0.5748 2MG|35MCG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BD MIA 3MG | 0.03MG TAB (ABB/PHA) DROSPIRENONE | ETHINYL ESTRADIOL 28'S C 21.34 3MG|0.03MG 0 2022-04-01 2024-03-31 0
40 7621BD MIA 3MG D/0.03MG EE TAB (ABB/PHA) DROSP/EE (C) 28'S C 21.34 3MG|0.03MG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BE MIA 3MG | 0.02MG TAB (ABB/PHA) DROSPIRENONE | ETHINYL ESTRADIOL 28'S C 19.52 3MG|0.02MG 0 2022-04-01 2024-03-31 0
40 7621BE MIA 3MG D/0.02MG EE TAB (ABB/PHA) DROSP/EE (C) 28'S C 19.52 3MG|0.02MG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BF PRIMAFEN 30MCG | 150MCG TAB (ABB/PHA) ETHINYLESTRADIOL | LEVONORGESTRE 21'S C 4.57 30MCG|150MCG 0 2022-04-01 2024-03-31 0
40 7621BF PRIMAFEN 30MCG|150MCG TAB (ABB/PHA) ETHINYLESTRADIOL|LEVONORGESTRE (C) 21'S C 4.57 30MCG|150MCG 2022-04-01 2023-03-31 No No Delete from contract 0
41 7621BM MINIGYNON 30MCG|50MCG TAB (BSP) ETHINYL ESTRADIOL|LEVONORGES (C) 21'S C 0.1294 30MCG|50MCG 0 2024-04-01 2026-03-31 0
41 7621BN ETHINYL ESTRADIOL|LEVONORGESTREL 30MCG|150MCG TAB (APO) (C) 28'S C 0.1631 30MCG|150MCG 0 2024-04-01 2026-03-31 0
41 7621BP APO-DROSPIRENONE|ETHINYL ESTRADIOL 3MG TAB (APO) (C) 28'S C 9.7044 3MG|0.02MG 0 2024-04-01 2026-03-31 0
41 7621BU MINIGYNON 30MCG|50MCG TAB (BSP) ETHINYL ESTRADIOL|LEVONORGES (C) 21'S C 2.7183 30MCG|50MCG 0 2024-04-01 2026-03-31 0