Drugs available on Contract - [ROCEPHIN 1G IV INJ (ROC) CEFTRIAXONE (C)], []

Contract Number	41
Brand Code	5641AK
Brand Name	ROCEPHIN 1G IV INJ (ROC) CEFTRIAXONE (C)
Active Ingredient	CEFTRIAXONE
Trade Name	ROCEPHIN
Package Size	1G VIAL
Formulary Category	C
Pkg Price	12.23
Unit Price	12.2325
Strength	1G IV
Unit Description	VIAL
Max. Reimbursable Quantity / Month	28
Package Description	VIAL
Manufacturer Code	ROC
Manufacturer Name	ROCHE SERVICIOS S.A.
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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	1G BD
SIGFactor	2
Dentist Allowed
Therapeutic Code	08120612
Therapeutic Desc	THIRD GEN CEPHALOSPORINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	THIRD GEN CEPHALOSPORINS
Amend Date