Drugs available on Contract - [OPTICHLOR SL 1% EYE OINTMENT], []

Contract Number	40
Brand Code	0125M
Brand Name	OPTICHLOR SL 1% EYE OINTMENT
Active Ingredient	CHLORAMPHENICOL
Trade Name	OPTICHLOR SL 1%
Package Size	5G
Formulary Category	A
Pkg Price	$4.35
Unit Price
Strength	1%
Unit Description
Max. Reimbursable Quantity / Month	1
Package Description	OINT
Manufacturer Code	SPC
Manufacturer Name
Agent Code	PSB
Agent Name	PHARMACEUTICAL SOLUTIONS
Benefit
Benefit Cat Code
Drug Contract Start Date	2023-06-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed
Therapeutic Code	520404
Therapeutic Desc	EENT ANTIBACTERIALS
Status Description
Default Route	EYE
Max Repeats	0
Therapeutic Head	EENT INFECTIVES
Amend Date	2023-06-09