Drugs available on Contract - [ARICEPT 5MG TAB (PFI) DONEPEZIL], []

Contract Number	42
Brand Code	44634
Brand Name	ARICEPT 5MG TAB (PFI) DONEPEZIL
Active Ingredient	DONEPEZIL
Trade Name	ARICEPT
Package Size	28'S
Formulary Category	C
Pkg Price	117.38
Unit Price	4.19
Strength	5MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	30
Package Description	BLIS
Manufacturer Code	PFI
Manufacturer Name	PFIZER CORPORATION
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
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	28
Dentist Allowed	N
Therapeutic Code	1204
Therapeutic Desc	PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
Amend Date