Drugs available on Contract - [XALATAN 0.005% EYE DR (PFI) LATANOPROST], []

Contract Number	42
Brand Code	A531BF
Brand Name	XALATAN 0.005% EYE DR (PFI) LATANOPROST
Active Ingredient	LATANOPROST
Trade Name	XALATAN
Package Size	2.5ML
Formulary Category	A
Pkg Price	8.51
Unit Price	8.51
Strength	0.005%
Unit Description	BOTT
Max. Reimbursable Quantity / Month	1
Package Description	BOTT
Manufacturer Code	PFI
Manufacturer Name	PFIZER CORPORATION
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	524028
Therapeutic Desc	EENT PROSTAGLANDIN ANALOGS
Status Description
Default Route	OPHTHALMIC
Max Repeats	6
Therapeutic Head	EENT PROSTAGLANDIN ANALOGS
Amend Date