Contracted Products [ACYCLOVIR 5% OINT (TOR/AHI) ]

Contract Number	40
Brand Name	ACYCLOVIR 5% OINT (TOR/AHI)
Package Size	15G
Formulary Category	C
Unit Price	69.32
Strength	5%
Max. Reimbursable / Month	0
Drug Contract Start Date	2022-04-01
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description
Max Repeats	0