Displaying 1 - 7 of 7
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 76219 FEMIANE 20MCG | 75MCG TAB (BSP/AHI) ETHINYLESTRADIOL | GESTODENE 21'S C 14.41 20MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621AZ CICLOTAB 20MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE 21'S C 15.98 20MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621AZ CICLOTAB 20MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) 21'S C 15.98 20MCG|75MCG 2022-04-01 2023-03-31 No No Delete from contract 0
40 7621BB CICLOTAB 30MCG | 75MCG TAB (ABB/PHA) ETHINYLESTRADIOL | GESTODENE 21'S C 15.98 30MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621BB CICLOTAB 30MCG|75MCG TAB (ABB/PHA) ETHINYLESTRADIOL|GESTODENE (C) 21'S C 15.98 30MCG|75MCG 2022-04-01 2023-03-31 No No Delete from contract 0
41 7621BV LINDYNETTE 20MCG|75MCG TAB (CHW) ETHINYL ESTRADIOL|GESTODENE (C) 21'S C 4.1047 20MCG|75MCG 0 2024-04-01 2026-03-31 0
40 7621G FEMIANE 20MCG | 75MCG TAB (BSP/COL) ETHINYLESTRADIOL | GESTODENE 21'S C 14.41 20MCG|75MCG 0 2022-04-01 2024-03-31 0