Contracted Products [CYCLOVAX 200MG TAB (REM) ACYCLOVIR (C)]

Contract Number	41
Brand Name	CYCLOVAX 200MG TAB (REM) ACYCLOVIR (C)
Package Size	3X10
Formulary Category	C
Unit Price	0.1495
Strength	200MG
Max. Reimbursable / Month	50
Drug Contract Start Date	2024-04-01
Drug Contract End Date	2026-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description
Max Repeats	0