Drugs available on Contract - [REFRESH TEARS 0.5% EYE DR (ALL) CARBOXYMETHYLCELLULOSE], []

Contract Number	42
Brand Code	4701B
Brand Name	REFRESH TEARS 0.5% EYE DR (ALL) CARBOXYMETHYLCELLULOSE
Active Ingredient	CARBOXYMETHYLCELLULOSE
Trade Name	REFRESH TEARS
Package Size	15ML
Formulary Category	C
Pkg Price	11.55
Unit Price	11.55
Strength	0.5%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	ALL
Manufacturer Name	ALLERGAN INTERNATIONAL
Agent Code	COL
Agent Name	AVENTA BARBADOS
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	5292
Therapeutic Desc	EENT DRUGS MISCELLANEOPUS
Status Description
Default Route	OPHTHALMIC
Max Repeats	0
Therapeutic Head	EENT DRUGS MISCELLANEOPUS
Amend Date