Drugs available on Contract - [MYCOPHENOLATE 360MG TAB (INP) (C)], []

Contract Number	41
Brand Code	A041N
Brand Name	MYCOPHENOLATE 360MG TAB (INP) (C)
Active Ingredient	MYCOPHENOLATE
Trade Name	MYCOPHENOLATE
Package Size	50'S
Formulary Category	C
Pkg Price	224.26
Unit Price	4.4852
Strength	360MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	0
Package Description	BOX
Manufacturer Code	INP
Manufacturer Name	INTAS PHARMACEUTICALS LTD
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE 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	UP TO IG
SIGFactor	0
Dentist Allowed
Therapeutic Code	9244
Therapeutic Desc	IMMUNOSUPPRESSIVE AGENTS
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	IMMUNOSUPPRESSIVE AGENTS
Amend Date