Drugs available on Contract - [ALBURX 25% INJ (CSL) HUMAN ALBUMIN], []

Contract Number	42
Brand Code	4941AG
Brand Name	ALBURX 25% INJ (CSL) HUMAN ALBUMIN
Active Ingredient	HUMAN ALBUMIN
Trade Name	ALBURX
Package Size	50ML VIAL
Formulary Category	BQ
Pkg Price	91.06
Unit Price	91.06
Strength	25%
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	CSL
Manufacturer Name	CSL BEHRING AG
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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	8004
Therapeutic Desc	SERUMS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	SERUMS
Amend Date	2025-11-10