Drugs available on Contract - [DEXTROSE|SODIUM CHLORIDE 5%|0.45% INJ (BAX)], []

Contract Number	42
Brand Code	3788D
Brand Name	DEXTROSE\|SODIUM CHLORIDE 5%\|0.45% INJ (BAX)
Active Ingredient	DEXTROSE\|SODIUM CHLORIDE
Trade Name	DEXTROSE\|SODIUM CHLORIDE
Package Size	500ML
Formulary Category	B
Pkg Price	6.25
Unit Price	6.25
Strength	5%\|0.45%
Unit Description	BAG
Max. Reimbursable Quantity / Month	50
Package Description	BAG
Manufacturer Code	BAX
Manufacturer Name	BAXTER EXPORT CORP.
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
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	4020
Therapeutic Desc	CALORIC AGENTS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	CALORIC AGENTS
Amend Date