Drugs available on Contract - [PENICILLAMINE 250MG CAP (JOL) ], []

Contract Number	41
Brand Code	53117
Brand Name	PENICILLAMINE 250MG CAP (JOL)
Active Ingredient	PENICILLAMINE
Trade Name	PENICILLAMINE
Package Size	50'S
Formulary Category	A
Pkg Price	70.49
Unit Price	1.4097
Strength	250MG
Unit Description	CAP
Max. Reimbursable Quantity / Month	180
Package Description	BOX
Manufacturer Code	JOL
Manufacturer Name	JOLLY PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode	QID
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	6400
Therapeutic Desc	HEAVY METAL ANTAGONISTS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	HEAVY METAL ANTAGONISTS
Amend Date