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 6691AD QLAIRA TAB (BSP/COL) ESTRADIOL/DIENOGEST 28'S C 0.97 3MG|3MG 0 2022-04-01 2024-03-31 0
41 6691AD QLAIRA TAB (BSP) ESTRADIOL/DIENOGEST (C) 28'S C 0.9708 3MG|3MG 0 2024-04-01 2026-03-31 0
42 6691AD QLAIRA 3MG|3MG TAB (BSP) DIENOGEST (C) 28'S C 0.82 3MG|3MG 0 2026-04-01 No No 0
40 6691AE QLAIRA TAB (BSP/AHI) ESTRADIOL/DIENOGEST 28'S C 0.97 3MG|3MG 0 2022-04-01 2024-03-31 0
41 6691AE QLAIRA TAB (BSP) ESTRADIOL/DIENOGEST (C) 28'S C 0.9708 3MG|3MG 0 2024-04-01 2026-03-31 0
42 6691AE QLAIRA 3MG|3MG TAB (BSP) DIENOGEST|ESTRADIOL 28'S C 0.90 3MG|3MG 0 2026-04-01 No No 0