Drugs available on Contract - [ELIQUIS 5MG TAB (PFI) APIXABAN], []

Contract Number	42
Brand Code	B1526
Brand Name	ELIQUIS 5MG TAB (PFI) APIXABAN
Active Ingredient	APIXABAN
Trade Name	ELIQUIS
Package Size	60'S
Formulary Category	B
Pkg Price	175.33
Unit Price	2.92
Strength	5MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	60
Package Description	BLIS
Manufacturer Code	PFI
Manufacturer Name	PFIZER CORPORATION
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	2026-03-05