Drugs available on Contract - [LEUCOVORIN 50MG INJ (SLS/AHI)], []

Contract Number	40
Brand Code	6432G
Brand Name	LEUCOVORIN 50MG INJ (SLS/AHI)
Active Ingredient	LEUCOVORIN
Trade Name	LEUCOVORIN
Package Size	10ML VIAL
Formulary Category	BQ
Pkg Price	22.29
Unit Price	22.29
Strength	50MG
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	SLS
Manufacturer Name	SAMARTH LIFE SCIENCES
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	0
Dentist Allowed	No
Therapeutic Code	9212
Therapeutic Desc	ANTIDOTES
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	UNCLASSIFIED THERAPEUTIC AGENTS
Amend Date