Drugs available on Contract - [PENICILLIN G SODIUM 5MU INJ (JOL)], []

Contract Number	42
Brand Code	0192A
Brand Name	PENICILLIN G SODIUM 5MU INJ (JOL)
Active Ingredient	PENICILLIN G SODIUM
Trade Name	PENICILLIN G SODIUM
Package Size	5G VIAL
Formulary Category	B
Pkg Price	7.23
Unit Price	7.23
Strength	5MU
Unit Description	VIAL
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	JOL
Manufacturer Name	JOLLY PHARMACEUTICALS
Agent Code	PHA
Agent Name	PHARMACY SALES CARIBBEAN
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	081216
Therapeutic Desc	PENICILLINS
Status Description
Default Route	IM
Max Repeats	0
Therapeutic Head	PENICILLINS
Amend Date