Drugs available on Contract - [PENTOXIFYLLINE 400MG TAB (HEA/ATB)], []

Contract Number	40
Brand Code	6091G
Brand Name	PENTOXIFYLLINE 400MG TAB (HEA/ATB)
Active Ingredient	PENTOXIFYLLINE
Trade Name	PENTOXIFYLLINE
Package Size	10X10
Formulary Category	A
Pkg Price	21.18
Unit Price	0.2118
Strength	400MG
Unit Description	TABLET IMMED
Max. Reimbursable Quantity / Month	90
Package Description
Manufacturer Code	HEA
Manufacturer Name	HEALTH 2000 INC
Agent Code	ATB
Agent Name	ANSA TRADING BARBADOS LTD
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-07-12
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode	1 TD
SIGFactor	3
Dentist Allowed	N
Therapeutic Code	2024
Therapeutic Desc	HEMORRHEOLOGICS
Status Description	la
Default Route	oral
Max Repeats	6
Therapeutic Head	HEMORRHEOLOGICS
Amend Date	2022-11-25