Drugs available on Contract - [PHENYTOIN 50MG/ML INJ (MON/PHA) ], []

Contract Number	40
Brand Code	1514M
Brand Name	PHENYTOIN 50MG/ML INJ (MON/PHA)
Active Ingredient	PHENYTOIN
Trade Name	PHENYTOIN
Package Size	5X5ML
Formulary Category	B
Pkg Price	7.80
Unit Price	1.56
Strength	50MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code	Anti-Epileptic
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2022-07-18
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	281212
Therapeutic Desc	HYDANTOINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	CENTRAL NERVOUS SYSTEM DRUGS
Amend Date