Drugs available on Contract - [PMS-CHOLESTYRAMINE 4G GRAN (PMS) ], []

Contract Number	41
Brand Code	1121KB
Brand Name	PMS-CHOLESTYRAMINE 4G GRAN (PMS)
Active Ingredient	CHOLESTYRAMINE
Trade Name	PMS-CHOLESTYRAMINE
Package Size	30X4G
Formulary Category	A
Pkg Price	53.01
Unit Price	1.7669
Strength	4G
Unit Description	SACH
Max. Reimbursable Quantity / Month	60
Package Description	BOX
Manufacturer Code	PMS
Manufacturer Name	PHARMASCIENCE
Agent Code	COL
Agent Name	COLLINS LTD
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	1 OD
SIGFactor	1
Dentist Allowed	N
Therapeutic Code	240604
Therapeutic Desc	BILE ACID SEQUESTRANTS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	BILE ACID SEQUESTRANTS
Amend Date