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

Contract Number	41
Brand Code	12136
Brand Name	NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL (BQ)
Active Ingredient	GLYCERYL TRINITRATE
Trade Name	NITROGLYCERINE
Package Size	25X5ML
Formulary Category	BQ
Pkg Price	171.25
Unit Price	6.8502
Strength	5MG/ML
Unit Description	AMP
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	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
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