Displaying 1 - 6 of 6
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
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 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
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