Displaying 1 - 8 of 8
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 5693AW VALTREX 500MG TAB (GSK/COL) VALACYCLOVIR 10'S C 6.19 500MG 0 2022-04-01 2024-03-31 0
41 5693AW VALTREX 500MG TAB (GSK) VALACYCLOVIR (C) 10'S C 6.8067 500MG 42 2024-04-01 2026-03-31 0
40 5693DU PMS-VALACYCLOVIR 500MG CAP (PMS/COL) 100'S A 0.60 500MG 42 2022-04-01 2024-03-31 0
41 5693FB APO-VALCYCLOVIR 500MG TAB (APO) VAL 100'S A 0.6788 500MG 42 2024-04-01 2026-03-31 0
42 5693FF VALOVERA 500MG TAB (JLP) VALACYCLOVIR 10X10 A 0.52 500MG 42 2026-04-01 No No 0
40 5693S VALTREX 500MG TAB (GSK/COL) VALACYCLOVIR 42'S C 5.99 500MG 0 2022-04-01 2024-03-31 0
41 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR (C) 42'S C 6.5893 500MG 42 2024-04-01 2026-03-31 0
42 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR 42'S C 6.92 500MG 42 2026-04-01 No No 0