Drugs available on Contract - [HYPROMELLOSE 0.3% EYE DR (ASL) ], []

Contract Number	41
Brand Code	2411B
Brand Name	HYPROMELLOSE 0.3% EYE DR (ASL)
Active Ingredient	HYPROMELLOSE
Trade Name	HYPROMELLOSE
Package Size	10ML
Formulary Category	A
Pkg Price	7.64
Unit Price	7.6385
Strength	0.3%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	ASL
Manufacturer Name	ASHFORD LABORATORIES LTD
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	5292
Therapeutic Desc	EENT DRUGS MISCELLANEOPUS
Status Description
Default Route	OPHTHALMIC
Max Repeats	6
Therapeutic Head	EENT DRUGS MISCELLANEOPUS
Amend Date