Drugs available on Contract - [LANTUS 100U/ML INJ (SFA/COL) GLARGINE], []

Contract Number	40
Brand Code	B2246
Brand Name	LANTUS 100U/ML INJ (SFA/COL) GLARGINE
Active Ingredient	GLARGINE
Trade Name	LANTUS
Package Size	10ML VIAL
Formulary Category	A
Pkg Price	67.96
Unit Price	67.96
Strength	100U/ML
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	5
Package Description	VIAL
Manufacturer Code	SFA
Manufacturer Name	SANOFI AVENTIS
Agent Code	COL
Agent Name	COLLINS LTD
Benefit	B
Benefit Cat Code	Anti-Diabetic
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	682008
Therapeutic Desc	INSULINS
Status Description
Default Route	SC
Max Repeats	6
Therapeutic Head	HORMONES AND SYNTHETIC SUBSTITUTES
Amend Date