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

Contract Number	41
Brand Code	12138
Brand Name	GLYCERYL TRINITRATE 5MG/ML INJ (MON (BQ)
Active Ingredient	GLYCERYL TRINITRATE
Trade Name	GLYCERYL TRINITRATE
Package Size	5X5ML
Formulary Category	BQ
Pkg Price	8.89
Unit Price	1.7778
Strength	5MG/ML
Unit Description	AMP
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
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