Drugs available on Contract - [CEFTRIAXONE 500MG IV INJ (LAF)], []

Contract Number	42
Brand Code	5642CF
Brand Name	CEFTRIAXONE 500MG IV INJ (LAF)
Active Ingredient	CEFTRIAXONE
Trade Name	CEFTRIAXONE
Package Size	50X500MG
Formulary Category	B
Pkg Price	79.78
Unit Price	1.60
Strength	500MG IV
Unit Description	VIAL
Max. Reimbursable Quantity / Month	28
Package Description	VIAL
Manufacturer Code	LAF
Manufacturer Name	LABORATORIOS ALFA
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2026-04-01
Drug Contract End Date	2028-03-31
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
SIGCode
SIGFactor	0
Dentist Allowed	N
Therapeutic Code	08120612
Therapeutic Desc	THIRD GEN CEPHALOSPORINS
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	THIRD GEN CEPHALOSPORINS
Amend Date