Drugs available on Contract - [ACTEMRA 20MG/ML INJ (ROC) TOCILIZUMAB (C)], []

Contract Number	41
Brand Code	4181C
Brand Name	ACTEMRA 20MG/ML INJ (ROC) TOCILIZUMAB (C)
Active Ingredient	TOCILIZUMAB
Trade Name	ACTEMRA
Package Size	10ML VIAL
Formulary Category	C
Pkg Price	706.76
Unit Price	706.7642
Strength	20MG/ML
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	ROC
Manufacturer Name	ROCHE SERVICIOS S.A.
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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	9236
Therapeutic Desc	DISEASE MODIFYING ANTIRHEUMATIC AGENTS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	DISEASE MODIFYING ANTIRHEUMATIC AGENTS
Amend Date