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

Contract Number	41
Brand Code	B151A
Brand Name	XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C)
Active Ingredient	RIVAROXABAN
Trade Name	XARELTO
Package Size	56'S
Formulary Category	C
Pkg Price	169.62
Unit Price	3.029
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	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
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