Drugs available on Contract - [NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL], []

Contract Number	42
Brand Code	12136
Brand Name	NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL
Active Ingredient	GLYCERYL TRINITRATE
Trade Name	NITROGLYCERINE
Package Size	25X5ML
Formulary Category	BQ
Pkg Price	171.93
Unit Price	6.88
Strength	5MG/ML
Unit Description	AMPG
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	SLS
Manufacturer Name	SAMARTH LIFE SCIENCES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	241208
Therapeutic Desc	NITRATES AND NITRITES
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	NITRATES AND NITRITES
Amend Date