Drugs available on Contract - [ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE], []

Contract Number	42
Brand Code	A4921
Brand Name	ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE
Active Ingredient	BRIMONIDINE
Trade Name	ALPHAGAN P
Package Size	10ML
Formulary Category	C
Pkg Price	45.94
Unit Price	45.94
Strength	0.1%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	ALL
Manufacturer Name	ALLERGAN INTERNATIONAL
Agent Code	COL
Agent Name	AVENTA BARBADOS
Benefit	B
Benefit Cat Code	Anti-Glaucoma
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	524004
Therapeutic Desc	EENT ALPHA ADRENERGIC AGONISTS
Status Description
Default Route	OPHTHALMIC
Max Repeats	6
Therapeutic Head	EENT ALPHA ADRENERGIC AGONISTS
Amend Date