Displaying 1 - 5 of 5
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 2791D OVESTIN 1MG VAG CR (ASP/STO) ESTRIOL 15G A 41.59 1MG 1 2022-04-01 2024-03-31 Add to Contract as Cat A 6
41 2791D OVESTIN 1MG VAG CR (ASG) ESTRIOL 15G A 41.9981 1MG 1 2024-04-01 2026-03-31 6
42 2791D OVESTIN 1MG VAG CR (ASG) ESTRIOL 15G A 45.80 1MG 1 2026-04-01 No No 6
41 27921 OVESTIN 0.5MG OV (ASG) ESTRIOL 15'S A 41.9981 0.5MG 1 2024-04-01 2026-03-31 6
42 27921 OVESTIN 0.5MG OV (ASG) ESTRIOL 15'S A 3.05 0.5MG 15 2026-04-01 No No Amend Protocol Quantity 6