Drugs available on Contract - [TESTOSTERONE 250MG/ML INJ (RTM/PHA) ], []

Contract Number	40
Brand Code	5083C
Brand Name	TESTOSTERONE 250MG/ML INJ (RTM/PHA)
Active Ingredient	TESTOSTERONE
Trade Name	TESTOSTERONE
Package Size	10X1ML
Formulary Category	BQ
Pkg Price	140.81
Unit Price	14.08
Strength	250MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	RTM
Manufacturer Name	PANPHARMA GMBH
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	No
Therapeutic Code	6808
Therapeutic Desc	ANDROGENS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HORMONES AND SYNTHETIC SUBSTITUTES
Amend Date