Drugs available on Contract - [ALPROSTADIL 500MCG/ML INJ (SLS/AHI) ], []

Contract Number	40
Brand Code	A1916
Brand Name	ALPROSTADIL 500MCG/ML INJ (SLS/AHI)
Active Ingredient	ALPROSTADIL
Trade Name	ALPROSTADIL
Package Size	1ML AMP
Formulary Category	BQ
Pkg Price	399.59
Unit Price	399.59
Strength	500MCG/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	AMP
Manufacturer Code	SLS
Manufacturer Name	SAMARTH LIFE SCIENCES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	241292
Therapeutic Desc	VASODILATING AGENTS, MISCELLANEOUS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	CARDIOVASCULAR DRUGS
Amend Date