Drugs available on Contract - [THALIDOMIDE 50MG CAP (DIL/AHI) ], []

Contract Number	40
Brand Code	55511
Brand Name	THALIDOMIDE 50MG CAP (DIL/AHI)
Active Ingredient	THALIDOMIDE
Trade Name	THALIDOMIDE
Package Size	30'S
Formulary Category	C
Pkg Price	62.25
Unit Price	2.08
Strength	50MG
Unit Description	CAPSULE
Max. Reimbursable Quantity / Month	0
Package Description	CAP
Manufacturer Code	DIL
Manufacturer Name	FRESENIUS KABI
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code	Anti-Neoplastic
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	30
Dentist Allowed	No
Therapeutic Code	9220
Therapeutic Desc	BIOLOGIC RESPONSE MODIFIER
Status Description
Default Route	Oral
Max Repeats	0
Therapeutic Head	UNCLASSIFIED THERAPEUTIC AGENTS
Amend Date