Drugs available on Contract - [DIMENHYDRINATE 50MG/ML INJ (LAF/AHI) ], []

Contract Number	40
Brand Code	2565Y
Brand Name	DIMENHYDRINATE 50MG/ML INJ (LAF/AHI)
Active Ingredient	DIMENHYDRINATE
Trade Name	DIMENHYDRINATE
Package Size	100X1ML
Formulary Category	B
Pkg Price	142.41
Unit Price
Strength	50MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	INJ
Manufacturer Code	LAF
Manufacturer Name	LABORATORIOS ALFA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	5622
Therapeutic Desc	ANTIEMETICS
Status Description	Change Local Agent
Default Route	Oral
Max Repeats	0
Therapeutic Head	GASTROINTESTINAL DRUGS
Amend Date	2022-02-03