Drugs available on Contract - [XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP], []

Contract Number	40
Brand Code	51311
Brand Name	XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP
Active Ingredient	LATANOPROST\|TIMOLOL
Trade Name	XALACOM
Package Size	2.5ML
Formulary Category	C
Pkg Price	37.89
Unit Price	37.89
Strength	0.005%\|0.5%
Unit Description	EYE DROP
Max. Reimbursable Quantity / Month	0
Package Description	BOTT
Manufacturer Code	PFI
Manufacturer Name	PFIZER CORPORATION
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
Benefit	B
Benefit Cat Code	Anti-Glaucoma
Drug Contract Start Date	2022-07-27
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	524092
Therapeutic Desc	ANTIGLAUCOMA AGENTS MISCELLANEOUS
Status Description	Price Change
Default Route	OPHTHALMIC
Max Repeats	0
Therapeutic Head	EYE, EAR, NOSE AND THROAT PREPARATIONS
Amend Date	2022-07-26