Drugs available on Contract - [PRADAX 110MG TAB (BOE) DABIGATRAN (BQ)], []

Contract Number	41
Brand Code	B1521
Brand Name	PRADAX 110MG TAB (BOE) DABIGATRAN (BQ)
Active Ingredient	DABIGATRAN
Trade Name	PRADAX
Package Size	3X10
Formulary Category	BQ
Pkg Price	96.64
Unit Price	3.2212
Strength	110MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BOX
Manufacturer Code	BOE
Manufacturer Name	BOEHRINGER INGELHEIM
Agent Code	STO
Agent Name	BRYDEN STOKES 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