Drugs available on Contract - [BERIATE 500IU INJ (CSL) FACTOR VIII], []

Contract Number	42
Brand Code	4582T
Brand Name	BERIATE 500IU INJ (CSL) FACTOR VIII
Active Ingredient	FACTOR VIII
Trade Name	BERIATE
Package Size	500IU VIAL
Formulary Category	BQ
Pkg Price	244.65
Unit Price	244.65
Strength	500IU
Unit Description	VIAL
Max. Reimbursable Quantity / Month	12
Package Description	VIAL
Manufacturer Code	CSL
Manufacturer Name	CSL BEHRING AG
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	2025-11-10