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

Contract Number	42
Brand Code	55511
Brand Name	THALIDOMIDE 50MG CAP (DIL)
Active Ingredient	THALIDOMIDE
Trade Name	THALIDOMIDE
Package Size	30'S
Formulary Category	C
Pkg Price	48.11
Unit Price	1.60
Strength	50MG
Unit Description	CAP
Max. Reimbursable Quantity / Month	0
Package Description	BLIS
Manufacturer Code	DIL
Manufacturer Name	FRESENIUS KABI
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	30
Dentist Allowed	N
Therapeutic Code	9220
Therapeutic Desc	BIOLOGIC RESPONSE MODIFIER
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	BIOLOGIC RESPONSE MODIFIER
Amend Date