Contracted Products [ACYCLOVIR 800MG DISP TAB (HEA) (C)]

Contract Number	42
Brand Name	ACYCLOVIR 800MG DISP TAB (HEA) (C)
Package Size	1X10
Formulary Category	B
Unit Price	0.69
Strength	800MG
Max. Reimbursable / Month	50
Drug Contract Start Date	2026-04-01
Drug Contract End Date
Restrict To Ophthalmologist	No
Restrict To Pulmonologist	No
Status Description	Add to Contract as Cat B
Max Repeats	0