Drugs available on Contract - [MIDAZOLAM 5MG/ML INJ (RTM) (B)], []

Contract Number	41
Brand Code	6211D
Brand Name	MIDAZOLAM 5MG/ML INJ (RTM) (B)
Active Ingredient	MIDAZOLAM
Trade Name	MIDAZOLAM
Package Size	10X3ML
Formulary Category	B
Pkg Price	36.5
Unit Price	3.65
Strength	5MG/ML
Unit Description	AMP
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	RTM
Manufacturer Name	PANPHARMA GMBH
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-05-25
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	10
Dentist Allowed	N
Therapeutic Code	282408
Therapeutic Desc	BENZODIAZEPINES (SEDATIVES)
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	BENZODIAZEPINES (SEDATIVES)
Amend Date	2024-04-01