Drugs available on Contract - [FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN], []

Contract Number	41
Brand Code	B4218
Brand Name	FORXIGA 5MG TAB (AZN) DAPAGLIFLOZIN
Active Ingredient	DAPAGLIFLOZIN
Trade Name	FORXIGA
Package Size	30'S
Formulary Category	A
Pkg Price	61.6
Unit Price	2.0532
Strength	5MG
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	2024-04-01
Drug Contract End Date	2024-04-24
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	2024-03-13