Drugs available on Contract - [VANCOMYCIN 1G INJ (MON/PHA) ], []

Contract Number	40
Brand Code	42934
Brand Name	VANCOMYCIN 1G INJ (MON/PHA)
Active Ingredient	VANCOMYCIN
Trade Name	VANCOMYCIN
Package Size	1G VIAL
Formulary Category	BQ
Pkg Price	10.41
Unit Price	10.41
Strength	1G
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	Anti-Neoplastic
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	No
Therapeutic Code	08122816
Therapeutic Desc	GLYCOPEPTIDES
Status Description
Default Route	IV
Max Repeats	6
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date