Displaying 1 - 15 of 15
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 6691AF BILIVE 1MG E/2MG D TAB (ABB/PHA) ESTRADIOL/DR 30'S C 1.00 2MG|1MG 0 2022-04-01 2024-03-31 0
40 7621AC YAZ 3MG | 0.02MG TAB (BSP/AHI) DROSPIRENONE | ETHINYLESTRADIOL 28'S C 19.03 3MG|0.02MG 0 2022-04-01 2024-03-31 0
40 7621AE YAZ 3MG | 0.02MG TAB (BSP/COL) DROSPIRENONE | ETHINYL ESTRADIOL 28'S C 19.03 3MG|0.02MG 0 2022-04-01 2024-03-31 0
41 7621AE 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
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
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
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 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
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
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