Displaying 1 - 20 of 29
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 29628 POSTINOR 750MCG TAB (CHW) LEVONORGESTREL (C) 2'S C 1.332 750MCG 2 2024-04-01 2026-03-31 0
42 29628 POSTINOR 750MCG TAB (CHW) LEVONORGESTREL 2'S C 1.77 750MCG 2 2026-04-01 No No 0
40 2962A POSTINOR SD 1.5MG TAB (CHW/AHI) LEVONORGESTRE 1'S C 12.23 1.5MG 0 2022-04-01 2022-09-30 0
41 2962A POSTINOR SD 1.5MG TAB (CHW) LEVONORGESTR (C) 1'S C 4.3765 1.5MG 1 2024-04-01 2026-03-31 0
42 2962A POSTINOR SD 1.5MG TAB (CHW) LEVONORGESTR 1'S C 4.76 1.5MG 1 2026-04-01 No No 0
42 2962AC ONE PILL 1.5MG TAB (HEA) LEVONORGESTREL 1'S C 3.21 1.5MG 1 2026-04-01 No No Price Change 0
42 2962AD LEEDOZ 1.5MG TAB (JLP) LEVONORGESTREL 1'S C 2.45 1.5MG 1 2026-04-01 No No 0
40 2962E ONE PILL 1.5MG TAB (HEA/RXP) LEVONORGESTREL 1'S B 3.81 1.5MG 0 2022-04-01 2024-03-31 6
40 2962EA ONE PILL 1.5MG TAB (HEA/ATB) LEVONORGESTREL(B) 1'S B 3.81 1.5MG 2022-12-07 2024-03-31 No No Change Local Agent 6
41 2962EA ONE PILL 1.5MG TAB (HEA) LEVONORGESTREL (C) 1'S C 3.7241 1.5MG 1 2024-04-01 2026-03-31 0
40 2962N BACKUP PLAN ONE STEP 1.5MG TAB (APO/COL) LEVO 1'S C 7.80 1.5MG 0 2022-04-01 2024-03-31 0
40 2962Q PINKPILL 1.5MG TAB (RYV/ALW) LEVONORGESTREL 1'S C 4.05 1.5MG 0 2022-04-01 2024-03-31 0
40 2962R POST DAY 1.5MG TAB (ABB/PHA) LEVONORGESTREL 1'S C 9.89 1.5MG 0 2022-04-01 2024-03-31 0
40 2962S SEGUIDET 1.5MG TAB (LAF/AHI) LEVONORGESTREL 1'S C 5.22 1.5MG 0 2022-04-01 2024-03-31 Change Local Agent 0
41 2962S SEGUIDET 1.5MG TAB (LAF) LEVONORGESTREL (C) 1'S C 5.4366 1.5MG 1 2024-04-01 2026-03-31 0
42 2962S SEGUIDET 1.5MG TAB (LAF) LEVONORGESTREL 1'S C 5.44 1.5MG 1 2026-04-01 No No 0
41 2962W LEVONORGESTREL 1.5MG TAB (LDP) (B) 1'S B 3.2892 1.5MG 1 2024-04-01 2026-03-31 0
42 2962W LEVONORGESTREL 1.5MG TAB (LDP) 1'S C 3.40 1.5MG 1 2026-04-01 No No 0
42 2962X POST DAY 1.5MG TAB (ABB) LEVONORGESTREL 1'S C 8.83 1.5MG 1 2026-04-01 No No 0
40 76121 MIRENA 52MG IUD (BSP/AHI) LEVONORGESTREL 1'S C 271.83 52MG 0 2022-04-01 2024-03-31 0