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

Contract Number	41
Brand Code	5692K
Brand Name	ACYCLOVIR 5% OINT (TOR)
Active Ingredient	ACYCLOVIR
Trade Name	ACYCLOVIR
Package Size	15G
Formulary Category	C
Pkg Price	69.32
Unit Price	69.3173
Strength	5%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	2
Package Description	BOX
Manufacturer Code	TOR
Manufacturer Name	TORRENT PHARMACEUTICALS
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
Benefit
Benefit Cat Code
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
SIGCode
SIGFactor
Dentist Allowed	N
Therapeutic Code	081832
Therapeutic Desc	NUCLEOSIDES AND NUCLEOTIDES
Status Description
Default Route	TOPICAL
Max Repeats	0
Therapeutic Head	NUCLEOSIDES AND NUCLEOTIDES
Amend Date