Drugs available on Contract - [SIRDALUD 4MG TAB (BCH) TIZANIDINE], []

Contract Number	42
Brand Code	7911Y
Brand Name	SIRDALUD 4MG TAB (BCH) TIZANIDINE
Active Ingredient	TIZANIDINE
Trade Name	SIRDALUD
Package Size	30'S
Formulary Category	C
Pkg Price	23.24
Unit Price	0.77
Strength	4MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	21
Package Description	BLIS
Manufacturer Code	BCH
Manufacturer Name	SANDOZ
Agent Code	COL
Agent Name	AVENTA BARBADOS
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	122020
Therapeutic Desc	NEUROMUSCULAR BLOCKING AGENTS
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	NEUROMUSCULAR BLOCKING AGENTS
Amend Date