Drugs available on Contract - [LASPRAZOLE 40MG INJ (LDP) PANTOPRAZOLE (B)], []

Contract Number	41
Brand Code	B042BX
Brand Name	LASPRAZOLE 40MG INJ (LDP) PANTOPRAZOLE (B)
Active Ingredient	PANTOPRAZOLE
Trade Name	LASPRAZOLE
Package Size	10X10ML
Formulary Category	B
Pkg Price	26.75
Unit Price	2.6748
Strength	40MG
Unit Description	VIAL
Max. Reimbursable Quantity / Month	7
Package Description	BOX
Manufacturer Code	LDP
Manufacturer Name	LABDHI PHARMA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
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