Contracted Products [ACTILYSE 50MG INJ (BOE/STO) ALTEPLASE]

Contract Number	40
Brand Name	ACTILYSE 50MG INJ (BOE/STO) ALTEPLASE
Package Size	2X50MG
Formulary Category	BQ
Unit Price	2,408.97
Strength	50MG
Max. Reimbursable / Month	0
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description
Max Repeats	0