Drugs available on Contract - [TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST], []

Contract Number	42
Brand Code	A531AZ
Brand Name	TRAVATAN BAK 0.004% EYE DR (NVS) TRAVOPROST
Active Ingredient	TRAVOPROST
Trade Name	TRAVATAN BAK
Package Size	2.5ML
Formulary Category	A
Pkg Price	10.82
Unit Price	10.82
Strength	0.004%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	NVS
Manufacturer Name	NOVARTIS CARIBE SA
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
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