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

Contract Number	42
Brand Code	A1916
Brand Name	ALPROSTADIL 500MCG/ML INJ (SLS)
Active Ingredient	ALPROSTADIL
Trade Name	ALPROSTADIL
Package Size	1ML AMP
Formulary Category	BQ
Pkg Price	398.07
Unit Price	398.07
Strength	500MCG/ML
Unit Description	AMPG
Max. Reimbursable Quantity / Month	7
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	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	241292
Therapeutic Desc	VASODILATING AGENTS, MISCELLANEOUS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	VASODILATING AGENTS, MISCELLANEOUS
Amend Date