Displaying 1 - 13 of 13
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
41 5641AK ROCEPHIN 1G IV INJ (ROC) CEFTRIAXONE (C) 1G VIAL C 12.2325 1G IV 28 2024-04-01 2026-03-31 0
42 5641AK ROCEPHIN 1G IV INJ (ROC) CEFTRIAXONE 1G VIAL C 12.23 1G IV 28 2026-04-01 No No 0
40 5641BT C TRI 1G IV/IM INJ (EMC/COL) CEFTRIAXONE 1G VIAL C 2.99 1G IV/IM 0 2022-04-01 2024-03-31 0
41 5641BT C TRI 1G IV/IM INJ (EMC) CEFTRIAXONE (C) 1G VIAL C 4.893 1G IV/IM 28 2024-04-01 2026-03-31 0
42 5641BT C TRI 1G IV/IM INJ (EMC) CEFTRIAXONE 1G VIAL B 4.89 1G IV/IM 28 2026-04-01 No No 0
40 5641EC CEFTRIAXONE 1G IV/IM INJ (KWA/ATB) 1G VIAL B 2.12 1G IV/IM 0 2022-04-01 2022-09-30 0
41 5641EC CEFTRIAXONE 1G IV/IM INJ (KWA) (B) 1G VIAL B 1.631 1G IV/IM 28 2024-04-01 2026-03-31 0
40 5641EW CEFTRIAXONE 1G IV/IM INJ (CHC/ATB) 1G VIAL B 1.11 1G IV/IM 0 2022-04-01 2024-03-31 6
40 5641EX LACEFT 1G IV/IM INJ (LDP/AHI) CEFTRIAXONE 10X1G B 1.72 1G IV/IM 0 2022-04-01 2024-03-31 6
41 5641FJ CEFTRIAXONE 1G IV/IM INJ (MCP) (B) 1G VIAL B 1.3048 1G IV/IM 28 2024-04-01 2024-12-27 0
41 5641FJ CEFTRIAXONE 1G IV/IM INJ (MCP) (B) 1G VIAL B 1.48 1G IV/IM 28 2024-12-28 2026-03-31 0
40 5642CE CEFTRIAXONE 500MG IV/IM INJ (MON/PHA) 500MG VIAL B 1.96 500MG IV/IM 0 2022-04-01 2024-03-31 6
42 5642CF CEFTRIAXONE 500MG IV INJ (LAF) 50X500MG B 1.60 500MG IV 28 2026-04-01 No No 0