Drugs available on Contract - [OCREVUS 300MG INJ (ROC) OCRELIZUMAB], []

Contract Number	42
Brand Code	4181W
Brand Name	OCREVUS 300MG INJ (ROC) OCRELIZUMAB
Active Ingredient	OCRELIZUMAB
Trade Name	OCREVUS
Package Size	10ML
Formulary Category	BQ
Pkg Price	15,779.87
Unit Price	15,779.87
Strength	300MG
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	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	9220
Therapeutic Desc	BIOLOGIC RESPONSE MODIFIER
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	BIOLOGIC RESPONSE MODIFIER
Amend Date