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

Contract Number	42
Brand Code	5694AF
Brand Name	ACYCLOVIR 5% CR (HEA)
Active Ingredient	ACYCLOVIR
Trade Name	ACYCLOVIR
Package Size	5G
Formulary Category	A
Pkg Price	1.41
Unit Price	1.41
Strength	5%
Unit Description	TUBE
Max. Reimbursable Quantity / Month	2
Package Description	TUBE
Manufacturer Code	HEA
Manufacturer Name	HEALTH 2000 INC
Agent Code	AHI
Agent Name	ARMSTRONG HEALTHCARE INC
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