Drugs available on Contract - [THALIX 100MG CAP (DIL) THALIDOMIDE], []

Contract Number	42
Brand Code	55521
Brand Name	THALIX 100MG CAP (DIL) THALIDOMIDE
Active Ingredient	THALIDOMIDE
Trade Name	THALIX
Package Size	30'S
Formulary Category	C
Pkg Price	60.18
Unit Price	2.01
Strength	100MG
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