Drugs available on Contract - [VANCOMYCIN 1G INJ (KWA/ATB) ], []

Contract Number	40
Brand Code	42931
Brand Name	VANCOMYCIN 1G INJ (KWA/ATB)
Active Ingredient	VANCOMYCIN
Trade Name	VANCOMYCIN
Package Size	1G VIAL
Formulary Category	BQ
Pkg Price	20.39
Unit Price	20.39
Strength	1G
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	KWA
Manufacturer Name	KWALITY PHARMACEUTICALS
Agent Code	ATB
Agent Name	ANSA TRADING BARBADOS LTD
Benefit
Benefit Cat Code	Anti-Neoplastic
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor	0
Dentist Allowed	No
Therapeutic Code	08122816
Therapeutic Desc	GLYCOPEPTIDES
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date	2022-03-30