Drugs available on Contract - [AMANTADINE 100MG CAP (CAM/AHI) ], []

Contract Number	40
Brand Code	6061B
Brand Name	AMANTADINE 100MG CAP (CAM/AHI)
Active Ingredient	AMANTADINE
Trade Name	AMANTADINE
Package Size	56'S
Formulary Category	C
Pkg Price	65.78
Unit Price	1.17
Strength	100MG
Unit Description	CAPSULE
Max. Reimbursable Quantity / Month	0
Package Description	CAP
Manufacturer Code	CAM
Manufacturer Name	MORNINGSIDE PHARMACEUTICALS
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	No
Therapeutic Code	081804
Therapeutic Desc	ADAMANTANES
Status Description
Default Route	Oral
Max Repeats	0
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date