Drugs available on Contract - [IMMUNINE 600IU INJ (BAX) FACTOR IX], []

Contract Number	41
Brand Code	58022
Brand Name	IMMUNINE 600IU INJ (BAX) FACTOR IX
Active Ingredient	FACTOR IX
Trade Name	IMMUNINE
Package Size	600IU VIAL
Formulary Category	BQ
Pkg Price	634.35
Unit Price	634.3481
Strength	600IU
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	BAX
Manufacturer Name	BAXTER EXPORT CORP.
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
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	0
Dentist Allowed	N
Therapeutic Code	202816
Therapeutic Desc	HEMOSTATICS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HEMOSTATICS
Amend Date