Drugs available on Contract - [ACYCLOVIR 5% OINT (TOR/AHI) ], []

Contract Number	40
Brand Code	5692K
Brand Name	ACYCLOVIR 5% OINT (TOR/AHI)
Active Ingredient	ACYCLOVIR
Trade Name	ACYCLOVIR
Package Size	15G
Formulary Category	C
Pkg Price	69.32
Unit Price	69.32
Strength	5%
Unit Description	OINT
Max. Reimbursable Quantity / Month	0
Package Description	TUBE
Manufacturer Code	TOR
Manufacturer Name	TORRENT PHARMACEUTICALS
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
Dentist Allowed	No
Therapeutic Code	081832
Therapeutic Desc	NUCLEOSIDES AND NUCLEOTIDES
Status Description
Default Route	TOPICAL
Max Repeats	0
Therapeutic Head	ANTI-INFECTIVE AGENTS
Amend Date