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

Contract Number	41
Brand Code	29428
Brand Name	HYDROXYPROGESTERONE 250MG/ML INJ (MON)
Active Ingredient	HYDROXYPROGESTERONE
Trade Name	HYDROXYPROGESTERONE
Package Size	5X1ML
Formulary Category	BQ
Pkg Price	12.88
Unit Price	2.577
Strength	250MG/ML
Unit Description	AMP
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
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	Q3M
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	6832
Therapeutic Desc	PROGESTINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	PROGESTINS
Amend Date