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

Contract Number	41
Brand Code	5552D
Brand Name	THALIDOMIDE 100MG CAP (SLS)
Active Ingredient	THALIDOMIDE
Trade Name	THALIDOMIDE
Package Size	30'S
Formulary Category	C
Pkg Price	63.5
Unit Price	2.1167
Strength	100MG
Unit Description	CAP
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	SLS
Manufacturer Name	SAMARTH LIFE SCIENCES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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
SIGFactor
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