Drugs available on Contract - [HEMOREL A 500IU INJ (RLS) FACTOR VI], []

Contract Number	42
Brand Code	4582P
Brand Name	HEMOREL A 500IU INJ (RLS) FACTOR VI
Active Ingredient	FACTOR VIII
Trade Name	HEMOREL A
Package Size	500IU VIAL
Formulary Category	BQ
Pkg Price	309.48
Unit Price	309.48
Strength	500IU
Unit Description	VIAL
Max. Reimbursable Quantity / Month	12
Package Description	VIAL
Manufacturer Code	RLS
Manufacturer Name	RELIANCE LIFE SCIENCES
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	202816
Therapeutic Desc	HEMOSTATICS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HEMOSTATICS
Amend Date