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

Contract Number	41
Brand Code	0164AW
Brand Name	AMPICILLIN 500MG INJ (MON) (BQ)
Active Ingredient	AMPICILLIN
Trade Name	AMPICILLIN
Package Size	500MG VIAL
Formulary Category	BQ
Pkg Price	1.85
Unit Price	1.8485
Strength	500MG
Unit Description	VIAL
Max. Reimbursable Quantity / Month	28
Package Description	VIAL
Manufacturer Code	MON
Manufacturer Name	MONTAGE PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code	15
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	N
Therapeutic Code	081216
Therapeutic Desc	PENICILLINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	PENICILLINS
Amend Date