Drugs available on Contract - [ACRYLARM 0.2% GEL (LPO) POLYACRYLIC ACID], []

Contract Number	42
Brand Code	4701T
Brand Name	ACRYLARM 0.2% GEL (LPO) POLYACRYLIC ACID
Active Ingredient	POLYACRYLIC ACID
Trade Name	ACRYLARM
Package Size	10G
Formulary Category	B
Pkg Price	20.39
Unit Price	20.39
Strength	0.2%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	1
Package Description	BOX
Manufacturer Code	LPO
Manufacturer Name	LABORATORIOS POEN S.A.
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	1
Dentist Allowed	N
Therapeutic Code	5292
Therapeutic Desc	EENT DRUGS MISCELLANEOPUS
Status Description
Default Route	OPHTHALMIC
Max Repeats	6
Therapeutic Head	EENT DRUGS MISCELLANEOPUS
Amend Date