Drugs available on Contract - [FLUPHENAZINE 25MG/ML INJ (MON) (B)], []

Contract Number	41
Brand Code	7472AB
Brand Name	FLUPHENAZINE 25MG/ML INJ (MON) (B)
Active Ingredient	FLUPHENAZINE
Trade Name	FLUPHENAZINE
Package Size	10ML
Formulary Category	B
Pkg Price	6.55
Unit Price	6.5512
Strength	25MG/ML
Unit Description	VIAL
Max. Reimbursable Quantity / Month	3
Package Description	VIAL
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	ALI
Agent Name	ALL HEALTH INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	28160824
Therapeutic Desc	PHENOTHIAZINES
Status Description
Default Route	IM
Max Repeats	6
Therapeutic Head	PHENOTHIAZINES
Amend Date