Drugs available on Contract - [DAPSONE 100MG TAB (GSK) ], []

Contract Number	41
Brand Code	0472J
Brand Name	DAPSONE 100MG TAB (GSK)
Active Ingredient	DAPSONE
Trade Name	DAPSONE
Package Size	1000'S
Formulary Category	A
Pkg Price	141.35
Unit Price	0.1414
Strength	100MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	90
Package Description	BOTT
Manufacturer Code	GSK
Manufacturer Name	GLAXOSMITHKLINE
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-07-05
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	081692
Therapeutic Desc	ANTIMYCOBACTERIALS, MISCELLANEOUS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	ANTIMYCOBACTERIALS, MISCELLANEOUS
Amend Date	2024-07-05