Drugs available on Contract - [DOXYCYCLINE 100MG INJ (CIR/AHI) ], []

Contract Number	40
Brand Code	5522C
Brand Name	DOXYCYCLINE 100MG INJ (CIR/AHI)
Active Ingredient	DOXYCYCLINE
Trade Name	DOXYCYCLINE
Package Size	100MG VIAL
Formulary Category	B
Pkg Price	35.23
Unit Price	35.23
Strength	100MG
Unit Description	INJECTION
Max. Reimbursable Quantity / Month	0
Package Description	VIAL
Manufacturer Code	CIR
Manufacturer Name	CIRON PHARMA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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	0
Dentist Allowed	Yes
Therapeutic Code	081224
Therapeutic Desc	TETRACYCLINES
Status Description
Default Route	IV
Max Repeats	6
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date