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

Contract Number	42
Brand Code	5692N
Brand Name	APO-ACYCLOVIR 5% OINT (APO)
Active Ingredient	ACYCLOVIR
Trade Name	APO-ACYCLOVIR
Package Size	4G
Formulary Category	A
Pkg Price	6.39
Unit Price	6.39
Strength	5%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	2
Package Description	TUBE
Manufacturer Code	APO
Manufacturer Name	APOTEX INC.
Agent Code	COL
Agent Name	AVENTA BARBADOS
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	081832
Therapeutic Desc	NUCLEOSIDES AND NUCLEOTIDES
Status Description
Default Route	TOPICAL
Max Repeats	0
Therapeutic Head	NUCLEOSIDES AND NUCLEOTIDES
Amend Date