Drugs available on Contract - [CONCERTA 18MG ER TAB (JAC) METHYLP (C)], []

Contract Number	41
Brand Code	17231
Brand Name	CONCERTA 18MG ER TAB (JAC) METHYLP (C)
Active Ingredient	METHYLPHENIDATE
Trade Name	CONCERTA
Package Size	30'S
Formulary Category	C
Pkg Price	130.43
Unit Price	4.3477
Strength	18MG
Unit Description	TABER
Max. Reimbursable Quantity / Month	42
Package Description	BOTT
Manufacturer Code	JAC
Manufacturer Name	JANSSEN-CILAG
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
Benefit
Benefit Cat Code	20
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2024-06-20
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	2820
Therapeutic Desc	RESPIRATORY-CEREBRAL STIMULANTS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	RESPIRATORY-CEREBRAL STIMULANTS
Amend Date	2024-06-18