Drugs available on Contract - [EPAQ 0.75% VAG CR (PMA/AHI) METRONIDAZOLE], []

Contract Number	40
Brand Code	04861
Brand Name	EPAQ 0.75% VAG CR (PMA/AHI) METRONIDAZOLE
Active Ingredient	METRONIDAZOLE
Trade Name	EPAQ
Package Size	40G
Formulary Category	A
Pkg Price	27.46
Unit Price	27.46
Strength	0.75%
Unit Description	VAGINAL CREA
Max. Reimbursable Quantity / Month	1
Package Description	TUBE
Manufacturer Code	PMA
Manufacturer Name	MORE PHARMA CORPORATION
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	083092
Therapeutic Desc	ANTIPROTOZOALS, MISCELLANEOUS
Status Description
Default Route	VAGINAL
Max Repeats	0
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date