Drugs available on Contract - [ITRACONAZOLE 100MG TAB (FSB)], []

Contract Number	42
Brand Code	5861MF
Brand Name	ITRACONAZOLE 100MG TAB (FSB)
Active Ingredient	ITRACONAZOLE
Trade Name	ITRACONAZOLE
Package Size	30'S
Formulary Category	A
Pkg Price	3.91
Unit Price	0.13
Strength	100MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description
Manufacturer Code	FSB
Manufacturer Name	FLAGSHIP BIOTECH
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
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	Add to Contract as Cat A
Default Route	ORAL
Max Repeats	3
Therapeutic Head	AZOLES
Amend Date	2026-03-05