Drugs available on Contract - [HYDRALLAZINE 20MG/ML INJ (DIL) (B)], []

Contract Number	41
Brand Code	1163K
Brand Name	HYDRALLAZINE 20MG/ML INJ (DIL) (B)
Active Ingredient	HYDRALLAZINE
Trade Name	HYDRALLAZINE
Package Size	25X1ML
Formulary Category	B
Pkg Price	938.75
Unit Price	37.5498
Strength	20MG/ML
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	DIL
Manufacturer Name	FRESENIUS KABI
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	240820
Therapeutic Desc	DIRECT VASODILATOR
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	DIRECT VASODILATOR
Amend Date