Drugs available on Contract - [BSS (BAG) SOLN (ALC) BALANCED SALT], []

Contract Number	42
Brand Code	4043A
Brand Name	BSS (BAG) SOLN (ALC) BALANCED SALT
Active Ingredient	BALANCED SALT
Trade Name	BSS (BAG)
Package Size	500ML
Formulary Category	BQ
Pkg Price	32.10
Unit Price	32.10
Strength
Unit Description	BAG
Max. Reimbursable Quantity / Month	10
Package Description	BAG
Manufacturer Code	ALC
Manufacturer Name	ALCON LABORATORIES INC.
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	5292
Therapeutic Desc	EENT DRUGS MISCELLANEOPUS
Status Description
Default Route	OPHTHALMIC
Max Repeats	0
Therapeutic Head	EENT DRUGS MISCELLANEOPUS
Amend Date