Drugs available on Contract - [HYDROXYPROGESTERONE 250MG/ML INJ (MON/PHA) ], []

Contract Number	40
Brand Code	29426
Brand Name	HYDROXYPROGESTERONE 250MG/ML INJ (MON/PHA)
Active Ingredient	HYDROXYPROGESTERONE
Trade Name	HYDROXYPROGESTERONE
Package Size	1ML AMP
Formulary Category	BQ
Pkg Price	3.62
Unit Price	3.62
Strength	250MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
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	6832
Therapeutic Desc	PROGESTINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HORMONES AND SYNTHETIC SUBSTITUTES
Amend Date