Drugs available on Contract - [FLUCONAZOLE 200MG TAB (GLP)], []

Contract Number	42
Brand Code	5861LT
Brand Name	FLUCONAZOLE 200MG TAB (GLP)
Active Ingredient	FLUCONAZOLE
Trade Name	FLUCONAZOLE
Package Size	30'S
Formulary Category	A
Pkg Price	12.23
Unit Price	0.41
Strength	200MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BLIS
Manufacturer Code	GLP
Manufacturer Name	GLENMARK PHARMACEUTICALS LTD
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	081408
Therapeutic Desc	AZOLES
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	AZOLES
Amend Date