Drugs available on Contract - [FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI], []

Contract Number	41
Brand Code	B4217
Brand Name	FORXIGA 10MG TAB (AZN) DAPAGLIFLOZI
Active Ingredient	DAPAGLIFLOZIN
Trade Name	FORXIGA
Package Size	30'S
Formulary Category	B
Pkg Price	61.6
Unit Price	2.0533
Strength	10MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	30
Package Description	BOX
Manufacturer Code	AZN
Manufacturer Name	ASTRAZENECA AB
Agent Code	COL
Agent Name	COLLINS LTD
Benefit	B
Benefit Cat Code	Anti-Diabetic
Drug Contract Start Date	2024-08-16
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	682018
Therapeutic Desc	SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
Status Description
Default Route	ORAL
Max Repeats	6
Therapeutic Head	SODIUM-GLUCOSE COTRANSPORTER INHIBITOR
Amend Date	2024-08-16