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

Contract Number	42
Brand Code	B1524
Brand Name	PRADAX 110MG TAB (BOE) DABIGATRAN
Active Ingredient	DABIGATRAN
Trade Name	PRADAX
Package Size	60'S
Formulary Category	B
Pkg Price	193.27
Unit Price	3.22
Strength	110MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BLIS
Manufacturer Code	BOE
Manufacturer Name	BOEHRINGER INGELHEIM
Agent Code	STO
Agent Name	BRYDEN STOKES LTD
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	20120412
Therapeutic Desc	DIRECT THROMBIN INHIBITORS
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	DIRECT THROMBIN INHIBITORS
Amend Date	2026-01-28