Drugs available on Contract - [FAMOTIDINE 10MG/ML INJ (MAT)], []

Contract Number	42
Brand Code	2592AM
Brand Name	FAMOTIDINE 10MG/ML INJ (MAT)
Active Ingredient	FAMOTIDINE
Trade Name	FAMOTIDINE
Package Size	25X2 ML
Formulary Category	BQ
Pkg Price	129.80
Unit Price	5.19
Strength	10MG/ML
Unit Description	AMPG
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	MAT
Manufacturer Name	MYLAN LABORATORIES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	562812
Therapeutic Desc	HISTAMINE RECEPTOR ANTAGONIST
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HISTAMINE RECEPTOR ANTAGONIST
Amend Date