Drugs available on Contract - [TRIVERAM 5MG|20MG|10MG TAB (SER) A (C)], []

Contract Number	42
Brand Code	B441N
Brand Name	TRIVERAM 5MG\|20MG\|10MG TAB (SER) A (C)
Active Ingredient	AMLODIPINE\|ATORVASTATIN\|PERINDOPRIL
Trade Name	TRIVERAM
Package Size	30'S
Formulary Category	C
Pkg Price	66.70
Unit Price	2.22
Strength	5MG\|20MG\|10MG
Unit Description	TAB
Max. Reimbursable Quantity / Month
Package Description
Manufacturer Code	SER
Manufacturer Name	LES LABORATOIRES SERVIER
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
Therapeutic Code	243204
Therapeutic Desc	ACE INHIBITORS
Status Description
Default Route	ORAL
Max Repeats
Therapeutic Head	ACE INHIBITORS
Amend Date	2026-04-07