Drugs available on Contract - [FOLISMART 5MG TAB (JLP) FOLIC ACID], []

Contract Number	42
Brand Code	3481BC
Brand Name	FOLISMART 5MG TAB (JLP) FOLIC ACID
Active Ingredient	FOLIC ACID
Trade Name	FOLISMART
Package Size	600'S
Formulary Category	A
Pkg Price	18.48
Unit Price	0.03
Strength	5MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BLIS
Manufacturer Code	JLP
Manufacturer Name	JOHN LEE PHARMACEUTICALS
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	8808
Therapeutic Desc	VITAMIN B COMPLEX
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	VITAMIN B COMPLEX
Amend Date