Drugs available on Contract - [BIMATOPROST 0.01% EYE DR (CIR) ], []

Contract Number	41
Brand Code	A531AW
Brand Name	BIMATOPROST 0.01% EYE DR (CIR)
Active Ingredient	BIMATOPROST
Trade Name	BIMATOPROST
Package Size	2.5ML
Formulary Category	A
Pkg Price	12.83
Unit Price	12.83
Strength	0.01%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	CIR
Manufacturer Name	CIRON PHARMA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit	B
Benefit Cat Code	Anti-Glaucoma
Drug Contract Start Date	2025-01-17
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist	Yes
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	524028
Therapeutic Desc	EENT PROSTAGLANDIN ANALOGS
Status Description
Default Route	OPHTHALMIC
Max Repeats	6
Therapeutic Head	EENT PROSTAGLANDIN ANALOGS
Amend Date	2025-01-17