Drugs available on Contract - [IMOVAX POLIO (AVP) POLIOMYELITIS], []

Contract Number	41
Brand Code	46121
Brand Name	IMOVAX POLIO (AVP) POLIOMYELITIS
Active Ingredient	POLIOMYELITIS
Trade Name	IMOVAX POLIO
Package Size	1 DOSE
Formulary Category	B
Pkg Price	24.46
Unit Price	24.4649
Strength	80AU
Unit Description	PFS
Max. Reimbursable Quantity / Month	1
Package Description	BOX
Manufacturer Code	AVP
Manufacturer Name	SANOFI PASTEUR
Agent Code	COL
Agent Name	COLLINS LTD
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2024-10-21
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	8012
Therapeutic Desc	VACCINES
Status Description
Default Route	IM
Max Repeats	0
Therapeutic Head	VACCINES
Amend Date	2024-09-09