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

Contract Number	42
Brand Code	A531J
Brand Name	LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST
Active Ingredient	BIMATOPROST
Trade Name	LUMIGAN
Package Size	2.5ML
Formulary Category	C
Pkg Price	41.32
Unit Price	41.32
Strength	0.01%
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	1
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