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

Contract Number	41
Brand Name	ACTILYSE 50MG INJ (BOE) ALTEPLASE (BQ)
Package Size	2X50MG
Formulary Category	BQ
Unit Price	2653.6143
Strength	50MG
Max. Reimbursable / Month	0
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description
Max Repeats	0