Drugs available on Contract - [DAPSONE 100MG TAB (LDP/AHI) ], []

Contract Number	40
Brand Code	0472A
Brand Name	DAPSONE 100MG TAB (LDP/AHI)
Active Ingredient	DAPSONE
Trade Name	DAPSONE
Package Size	100'S
Formulary Category	A
Pkg Price	32.62
Unit Price	0.33
Strength	100MG
Unit Description	TABLET
Max. Reimbursable Quantity / Month	90
Package Description	TAB
Manufacturer Code	LDP
Manufacturer Name	LABDHI PHARMA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	081692
Therapeutic Desc	ANTIMYCOBACTERIALS, MISCELLANEOUS
Status Description
Default Route	Oral
Max Repeats	6
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date