Drugs available on Contract - [BRILINTA 90MG TAB (AZN) TICAGRELOR (C)], []

Contract Number	41
Brand Code	3921CH
Brand Name	BRILINTA 90MG TAB (AZN) TICAGRELOR (C)
Active Ingredient	TICAGRELOR
Trade Name	BRILINTA
Package Size	60'S
Formulary Category	C
Pkg Price	122.32
Unit Price	2.0387
Strength	90MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BOX
Manufacturer Code	AZN
Manufacturer Name	ASTRAZENECA AB
Agent Code	COL
Agent Name	COLLINS LTD
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	201218
Therapeutic Desc	PLATELET AGGREGATION INHIBITORS
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	PLATELET AGGREGATION INHIBITORS
Amend Date