Drugs available on Contract - [GADOVIST 604MG/ML INJ (BSP/AHI) GADOBUTROL], []

Contract Number	40
Brand Code	6734AC
Brand Name	GADOVIST 604MG/ML INJ (BSP/AHI) GADOBUTROL
Active Ingredient	GADOBUTROL
Trade Name	GADOVIST
Package Size	7.5ML
Formulary Category	BQ
Pkg Price	135.43
Unit Price	135.43
Strength	604MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	BSP
Manufacturer Name	BAYER SCHERING PHARMA AG.
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	3668
Therapeutic Desc	ROENTGENOGRAPHY
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	DIAGNOSTIC AGENTS
Amend Date