Drugs available on Contract - [OMALIREL 150MG INJ (RLS) OMALIZUMAB], []

Contract Number	42
Brand Code	B4913
Brand Name	OMALIREL 150MG INJ (RLS) OMALIZUMAB
Active Ingredient	OMALIZUMAB
Trade Name	OMALIREL
Package Size	150MG VIAL
Formulary Category	BQ
Pkg Price	747.54
Unit Price	747.54
Strength	150MG
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	RLS
Manufacturer Name	RELIANCE LIFE SCIENCES
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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
Dentist Allowed	N
Therapeutic Code	4810
Therapeutic Desc	RESPIRATORY INFLAMMATORY AGENTS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	RESPIRATORY INFLAMMATORY AGENTS
Amend Date