Drugs available on Contract - [ACULAR LS 0.4% EYE DR (ALL) KETOROLAC], []

Contract Number	42
Brand Code	41458
Brand Name	ACULAR LS 0.4% EYE DR (ALL) KETOROLAC
Active Ingredient	KETOROLAC
Trade Name	ACULAR LS
Package Size	5ML
Formulary Category	C
Pkg Price	26.64
Unit Price	26.64
Strength	0.4%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	0
Package Description	BOTT
Manufacturer Code	ALL
Manufacturer Name	ALLERGAN INTERNATIONAL
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
SIGFactor	1
Dentist Allowed	N
Therapeutic Code	5208
Therapeutic Desc	EENT ANTI-INFLAMMATORY AGENTS
Status Description
Default Route	OPHTHALMIC
Max Repeats	0
Therapeutic Head	EENT ANTI-INFLAMMATORY AGENTS
Amend Date