Drugs available on Contract - [HISTAL DC 2MG|30MG TAB (CAR) CHLORPHENIRAMINE|PSEUDOEPHEDRIN], []

Contract Number	42
Brand Code	3791W
Brand Name	HISTAL DC 2MG\|30MG TAB (CAR) CHLORPHENIRAMINE\|PSEUDOEPHEDRIN
Active Ingredient	CHLORPHENIRAMINE\|PSEUDOEPHEDRINE
Trade Name	HISTAL DC
Package Size	150'S
Formulary Category	C
Pkg Price	48.93
Unit Price	0.33
Strength	2MG\|30MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	0
Package Description	BOTT
Manufacturer Code	CAR
Manufacturer Name	CARLISLE LABORATORIES LTD
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	ADULT :TW
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	0408
Therapeutic Desc	SECOND GENERATION ANTIHISTAMINES
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	SECOND GENERATION ANTIHISTAMINES
Amend Date