Drugs available on Contract - [ZOVIRAX 5% CR (GSK) ACYCLOVIR], []

Contract Number	42
Brand Code	56944
Brand Name	ZOVIRAX 5% CR (GSK) ACYCLOVIR
Active Ingredient	ACYCLOVIR
Trade Name	ZOVIRAX
Package Size	5G
Formulary Category	C
Pkg Price	25.50
Unit Price	25.50
Strength	5%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	2
Package Description	BOX
Manufacturer Code	GSK
Manufacturer Name	GLAXOSMITHKLINE
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	2026-02-16