Drugs available on Contract - [ORPHENADRINE 30MG/ML INJ (AKI/AHI) ], []

Contract Number	40
Brand Code	7912E
Brand Name	ORPHENADRINE 30MG/ML INJ (AKI/AHI)
Active Ingredient	ORPHENADRINE
Trade Name	ORPHENADRINE
Package Size	10X2ML
Formulary Category	C
Pkg Price	690.07
Unit Price	69.01
Strength	30MG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	AKI
Manufacturer Name	AKORN INC.
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2022-09-30
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	122092
Therapeutic Desc	SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	AUTONOMIC DRUGS
Amend Date	2022-03-29