Drugs available on Contract - [MIRCERA PREFILL 200MCG INJ (ROC) EPOIETI], []

Contract Number	42
Brand Code	7363A
Brand Name	MIRCERA PREFILL 200MCG INJ (ROC) EPOIETI
Active Ingredient	EPOIETIN BETA
Trade Name	MIRCERA PREFILL
Package Size	200MCG SYN
Formulary Category	B
Pkg Price	685.02
Unit Price	685.02
Strength	200MCG
Unit Description	PFS
Max. Reimbursable Quantity / Month	7
Package Description	BOX
Manufacturer Code	ROC
Manufacturer Name	ROCHE SERVICIOS S.A.
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	1
Dentist Allowed	N
Therapeutic Code	2016
Therapeutic Desc	HEMATOPOIETIC
Status Description
Default Route	IV
Max Repeats	0
Therapeutic Head	HEMATOPOIETIC
Amend Date