Drugs available on Contract - [NEXIUM 40MG INJ (AZN) PANTOPRAZOLE], []

Contract Number	42
Brand Code	B042BL
Brand Name	NEXIUM 40MG INJ (AZN) PANTOPRAZOLE
Active Ingredient	PANTOPRAZOLE
Trade Name	NEXIUM
Package Size	5ML VIAL
Formulary Category	C
Pkg Price	14.35
Unit Price	14.35
Strength	40MG
Unit Description	VIAL
Max. Reimbursable Quantity / Month	7
Package Description	VIAL
Manufacturer Code	AZN
Manufacturer Name	ASTRAZENECA AB
Agent Code	COL
Agent Name	AVENTA BARBADOS
Benefit
Benefit Cat Code
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	562836
Therapeutic Desc	PROTON PUMP INHIBITORS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	PROTON PUMP INHIBITORS
Amend Date