Drugs available on Contract - [ACYCLOVIR DISP 400MG TAB (HEA) ], []

Contract Number	41
Brand Code	5696AB
Brand Name	ACYCLOVIR DISP 400MG TAB (HEA)
Active Ingredient	ACYCLOVIR
Trade Name	ACYCLOVIR
Package Size	1X10
Formulary Category	A
Pkg Price	4.02
Unit Price	0.4023
Strength	400MG
Unit Description	TABDISP
Max. Reimbursable Quantity / Month	50
Package Description	BOX
Manufacturer Code	HEA
Manufacturer Name	HEALTH 2000 INC
Agent Code	ATB
Agent Name	ANSA TRADING BARBADOS LTD
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	0
Dentist Allowed	N
Therapeutic Code	081832
Therapeutic Desc	NUCLEOSIDES AND NUCLEOTIDES
Status Description
Default Route	ORAL
Max Repeats	0
Therapeutic Head	NUCLEOSIDES AND NUCLEOTIDES
Amend Date