Displaying 1 - 4 of 4
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 6691M ANGELIQ 1MG E/2MG D TAB (BSP) ESTRADIOL/ (C) 28'S C 26.6124 2MG|1MG 0 2024-04-01 2026-03-31 0
42 6691M ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL 28'S C 26.61 2MG|1MG 0 2026-04-01 No No 0
41 6691N ANGELIQ 1MG E/2MG D TAB (BSP) ESTRADIOL/ (C) 28'S C 26.6124 2MG|1MG 0 2024-04-01 2026-03-31 0
42 6691N ANGELIQ 2MG|1MG TAB (BSP) DROSPIRENONE|ESTRADIOL 28'S C 24.22 2MG|1MG 0 2026-04-01 No No 0