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

Contract Number	42
Brand Code	6734AC
Brand Name	GADOVIST 604MG/ML INJ (BSP) GADOBUT
Active Ingredient	GADOBUTROL
Trade Name	GADOVIST
Package Size	7.5ML
Formulary Category	C
Pkg Price	135.73
Unit Price	135.73
Strength	604MG/ML
Unit Description	VIAL
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	2026-04-01
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	3668
Therapeutic Desc	ROENTGENOGRAPHY
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	ROENTGENOGRAPHY
Amend Date