Contracted Products [ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL

Contracted Products [ALYSENA 30MCG | 150MCG TAB (APO/COL) ETHINYLESTRADIOL | LEVONORGESTRE]

Contract Number	40
Brand Name	ALYSENA 30MCG \| 150MCG TAB (APO/COL) ETHINYLESTRADIOL \| LEVONORGESTRE
Package Size	28'S
Formulary Category	C
Unit Price	13.59
Strength	30MCG\|150MCG
Max. Reimbursable / Month	0
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description
Max Repeats	0