Drugs available on Contract - [HYDROXYCOBALAMINE 1MG/ML INJ (RTM)], []

Contract Number	42
Brand Code	4811D
Brand Name	HYDROXYCOBALAMINE 1MG/ML INJ (RTM)
Active Ingredient	HYDROXYCOBALAMINE
Trade Name	HYDROXYCOBALAMINE
Package Size	10X1ML
Formulary Category	B
Pkg Price	13.86
Unit Price	1.39
Strength	1MG/ML
Unit Description	AMPG
Max. Reimbursable Quantity / Month	3
Package Description	BOX
Manufacturer Code	RTM
Manufacturer Name	PANPHARMA GMBH
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
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	8808
Therapeutic Desc	VITAMIN B COMPLEX
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	VITAMIN B COMPLEX
Amend Date