Drugs available on Contract - [XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C)], []

Contract Number	41
Brand Code	B1517
Brand Name	XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C)
Active Ingredient	RIVAROXABAN
Trade Name	XARELTO
Package Size	28'S
Formulary Category	C
Pkg Price	84.81
Unit Price	3.0289
Strength	2.5MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BOX
Manufacturer Code	BSP
Manufacturer Name	BAYER SCHERING PHARMA AG.
Agent Code	COL
Agent Name	COLLINS LTD
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	20120412
Therapeutic Desc	DIRECT THROMBIN INHIBITORS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	DIRECT THROMBIN INHIBITORS
Amend Date