Drugs available on Contract - [HEPARIN 5000U/ML INJ (GLN) (B)], []

Contract Number	41
Brand Code	1011H
Brand Name	HEPARIN 5000U/ML INJ (GLN) (B)
Active Ingredient	HEPARIN
Trade Name	HEPARIN
Package Size	25X5ML
Formulary Category	B
Pkg Price	252.29
Unit Price	10.0915
Strength	5000U/ML
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	GLN
Manufacturer Name	GLAND
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	20120416
Therapeutic Desc	HEPARINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HEPARINS
Amend Date