Drugs available on Contract - [PROCTO-GLYVENOL 40MG|400MG CR (GSK) LIDOCAINE|TRIBENOSIDE], []

Contract Number	42
Brand Code	3294B
Brand Name	PROCTO-GLYVENOL 40MG\|400MG CR (GSK) LIDOCAINE\|TRIBENOSIDE
Active Ingredient	LIDOCAINE\|TRIBENOSIDE
Trade Name	PROCTO-GLYVENOL
Package Size	30G
Formulary Category	A
Pkg Price	7.99
Unit Price	7.99
Strength	40MG\|400MG
Unit Description	TUBE
Max. Reimbursable Quantity / Month	1
Package Description	BOX
Manufacturer Code	GSK
Manufacturer Name	GLAXOSMITHKLINE
Agent Code	COL
Agent Name	AVENTA BARBADOS
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	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