Drugs available on Contract - [DEXTROSE 5% INJ (CSC/PHA) ], []

Contract Number	40
Brand Code	20523
Brand Name	DEXTROSE 5% INJ (CSC/PHA)
Active Ingredient	DEXTROSE
Trade Name	DEXTROSE
Package Size	250ML
Formulary Category	B
Pkg Price	3.02
Unit Price	3.02
Strength	5%
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	BOTT
Manufacturer Code	CSC
Manufacturer Name	FORSURE MEDICAL
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-06-16
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	1
Dentist Allowed	No
Therapeutic Code	4020
Therapeutic Desc	CALORIC AGENTS
Status Description	Price Change
Default Route	IV
Max Repeats	0
Therapeutic Head	ELECTROLYTIC, CALORIC, AND WATER BALANCE
Amend Date	2022-06-15