Drugs available on Contract - [PREPARATION H 0.25% SUPPOS (GSK) PH], []

Contract Number	41
Brand Code	32936
Brand Name	PREPARATION H 0.25% SUPPOS (GSK) PH
Active Ingredient	PHENYLEPHRINE
Trade Name	PREPARATION H
Package Size	12'S
Formulary Category	A
Pkg Price	14.79
Unit Price	1.2323
Strength	0.25%
Unit Description	SUPP
Max. Reimbursable Quantity / Month	12
Package Description	BOX
Manufacturer Code	GSK
Manufacturer Name	GLAXOSMITHKLINE
Agent Code	COL
Agent Name	COLLINS LTD
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	APPLY BD
SIGFactor	1
Dentist Allowed	N
Therapeutic Code	8406
Therapeutic Desc	ANTI-INFLAMMATORY AGENTS, TOPICAL
Status Description
Default Route	TOPICAL
Max Repeats	6
Therapeutic Head	ANTI-INFLAMMATORY AGENTS, TOPICAL
Amend Date