Drugs available on Contract - [AMPICILLIN 500MG INJ (MON/PHA) ], []

Contract Number	40
Brand Code	0164AW
Brand Name	AMPICILLIN 500MG INJ (MON/PHA)
Active Ingredient	AMPICILLIN
Trade Name	AMPICILLIN
Package Size	500MG VIAL
Formulary Category	C
Pkg Price	1.69
Unit Price	1.69
Strength	500MG
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	Yes
Therapeutic Code	081216
Therapeutic Desc	PENICILLINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date