Drugs available on Contract - [DESIRE JELLY (HEA) LUBRICATING JELLY], []

Contract Number	42
Brand Code	4631AD
Brand Name	DESIRE JELLY (HEA) LUBRICATING JELLY
Active Ingredient	GLYCERINE
Trade Name	DESIRE
Package Size	82G
Formulary Category	B
Pkg Price	3.23
Unit Price	3.23
Strength
Unit Description	TUBE
Max. Reimbursable Quantity / Month	0
Package Description	TUBE
Manufacturer Code	HEA
Manufacturer Name	HEALTH 2000 INC
Agent Code	CWS
Agent Name	CAPSULE WHOLESALE
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	8436
Therapeutic Desc	MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
Status Description
Default Route	TOPICAL
Max Repeats	0
Therapeutic Head	MUCOUS-SKIN PREPARATIONS,MISCE LLANEOUS
Amend Date	2026-01-26