Drugs available on Contract - [GRAVOL INFANT 25MG SUPPOS (CDC) DIMENHYD], []

Contract Number	41
Brand Code	25643
Brand Name	GRAVOL INFANT 25MG SUPPOS (CDC) DIMENHYD
Active Ingredient	DIMENHYDRINATE
Trade Name	GRAVOL INFANT
Package Size	10'S
Formulary Category	A
Pkg Price	10.38
Unit Price	1.0384
Strength	25MG
Unit Description	SUPP
Max. Reimbursable Quantity / Month	10
Package Description	BOX
Manufacturer Code	CDC
Manufacturer Name	CHURCH & DWIGHT CANADA CORP
Agent Code	COL
Agent Name	COLLINS LTD
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2024-12-03
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	5622
Therapeutic Desc	ANTIEMETICS
Status Description
Default Route	RECTAL
Max Repeats	0
Therapeutic Head	ANTIEMETICS
Amend Date	2024-12-03