Drugs available on Contract - [PHYTOMENADIONE 1MG IM INJ (SLS)], []

Contract Number	42
Brand Code	3522M
Brand Name	PHYTOMENADIONE 1MG IM INJ (SLS)
Active Ingredient	PHYTOMENADIONE
Trade Name	PHYTOMENADIONE
Package Size	25X0.5ML
Formulary Category	B
Pkg Price	214.75
Unit Price	8.59
Strength	1MG IM
Unit Description	AMPG
Max. Reimbursable Quantity / Month	2
Package Description
Manufacturer Code	SLS
Manufacturer Name	SAMARTH LIFE SCIENCES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-02
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed
Therapeutic Code	8824
Therapeutic Desc	VITAMIN K ACTIVITY
Status Description
Default Route	IM
Max Repeats	0
Therapeutic Head	VITAMIN K ACTIVITY
Amend Date	2026-04-02