Displaying 4701 - 4720 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 7621BV LINDYNETTE 20MCG|75MCG TAB (CHW) ETHINYL ESTRADIOL|GESTODENE (C) 21'S C 4.1047 20MCG|75MCG 0 2024-04-01 2026-03-31 0
41 7621BX APO-DROSPIRENONE|ETHINYL ESTRADIOL 3MG|0.03MG TAB (APO) (C) 21'S C 9.7044 3MG|0.03MG 0 2024-04-01 2026-03-31 0
42 7621BZ MYA 3MG|0.02MG TAB (APO) DROSPIRENONE|ETHINYL ESTRADIOL 28'S C 9.70 3MG|0.02MG 0 2026-04-01 No No 0
42 7621CC MIA 3MG|0.02MG TAB (ABB) DROSPIRENONE|ETHINYL ESTRADIOL 28'S C 17.40 3MG|0.02MG 0 2026-04-01 No No 0
40 7621G FEMIANE 20MCG | 75MCG TAB (BSP/COL) ETHINYLESTRADIOL | GESTODENE 21'S C 14.41 20MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621S DIANE 35 2MG | 35MCG TAB (BSP/COL) CYPROTERONE | ETHINYL ESTRADIOL 21'S C 14.95 2MG|35MCG 0 2022-04-01 2024-03-31 0
41 7621S DIANE 35 2MG|35MCG TAB (BSP) CYPROTERONE|ETHINYL ESTRADIOL (C) 21'S C 14.9508 2MG|35MCG 0 2024-04-01 2026-03-31 0
42 7621S DIANE 35 2MG|35MCG TAB (BSP) CYPROTERONE|ETHINYL ESTRADIOL 21'S C 13.62 2MG|35MCG 0 2026-04-01 No No 0
40 7621T DIANE 35 2MG | 35MCG TAB (BSP/AHI) CYPROTERONE | ETHINYL ESTRADIOL 21'S C 14.95 2MG|35MCG 0 2022-04-01 2024-03-31 0
41 7621T DIANE 35 2MG|35MCG TAB (BSP) CYPROTERONE|ETHINYL ESTRADIOL (C) 21'S C 14.9508 2MG|35MCG 0 2024-04-01 2026-03-31 0
42 7621T DIANE 35 2MG|35MCG TAB (BSP) CYPROTERONE|ETHINYL ESTRADIOL 21'S C 14.95 2MG|35MCG 0 2026-04-01 No No 0
40 7621W YASMIN 3MG | 0.03MG TAB (BSP/COL) DROSPIRENONE | ETHINYL ESTRADIOL 21'S C 18.76 3MG|0.03MG 0 2022-04-01 2024-03-31 0
41 7621W YASMIN 3MG|0.03MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL (C) 21'S C 18.7564 3MG|0.03MG 0 2024-04-01 2026-03-31 0
42 7621W YASMIN 3MG|0.03MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL 21'S C 17.07 3MG|0.03MG 0 2026-04-01 No No 0
40 7621X YASMIN 3MG | 0.03MG TAB (BSP/AHI) DROSPIRENONE | ETHINYL ESTRADIOL 21'S C 18.76 3MG|0.03MG 0 2022-04-01 2024-03-31 0
41 7621X YASMIN 3MG|0.03MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL (C) 21'S C 18.7564 3MG|0.03MG 0 2024-04-01 2026-03-31 0
42 7621X YASMIN 3MG|0.03MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL 21'S C 18.76 3MG|0.03MG 0 2026-04-01 No No 0
40 7621Y MICROGYNON-30 30MCG | 150MCG TAB (BSP/AHI) ETHI 21'S B 4.49 30MCG|150MCG 0 2022-04-01 2024-03-31 0
41 7621Y MICROGYNON-30 30MCG|150MCG TAB (BSP) ETH (B) 21'S B 4.4852 30MCG|150MCG 3 2024-04-01 2026-03-31 6
42 7621Y MICROGYNON-30 30MCG|150MCG TAB (BSP) ETHINYL ESTRADIOL|LEVON 21'S B 3.34 30MCG|150MCG 3 2026-04-01 No No 6