Drugs available on Contract - [ADENOSINE 3MG/ML INJ (MON)], []

Contract Number	42
Brand Code	A151H
Brand Name	ADENOSINE 3MG/ML INJ (MON)
Active Ingredient	ADENOSINE
Trade Name	ADENOSINE
Package Size	10X2ML
Formulary Category	BQ
Pkg Price	17.83
Unit Price	1.78
Strength	3MG/ML
Unit Description	AMPG
Max. Reimbursable Quantity / Month	30
Package Description	BOX
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
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
Dentist Allowed	N
Therapeutic Code	240404
Therapeutic Desc	ANTIARRHYTHMIC AGENTS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	ANTIARRHYTHMIC AGENTS
Amend Date