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

Contract Number	41
Brand Code	B421M
Brand Name	DAPAGLIFLOZIN 5MG TAB (MCP)
Active Ingredient	DAPAGLIFLOZIN
Trade Name	DAPAGLIFLOZIN
Package Size	100'S
Formulary Category	A
Pkg Price	34.44
Unit Price	0.3444
Strength	5MG
Unit Description	TAB
Max. Reimbursable Quantity / Month	30
Package Description	BLIS
Manufacturer Code	MCP
Manufacturer Name	MACLEODS PHARMACEUTICALS LTD
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit	B
Benefit Cat Code	Anti-Diabetic
Drug Contract Start Date	2024-10-29
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed
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	2024-09-20