VALACICLOVIR
valaciclovir 500 mg tablet, 100
VALACICLOVIR (6280M)
6280M
Manner of administration:Oral
Restriction (Streamlined authority code: 9267)
Indication: Cytomegalovirus infection and disease
Treatment phase: Prophylaxis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 5 | Max qty units: 500 | # of repeats: 2 | DPMQ: $216.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $230.93 | Max safety net: $25.00 | General Patient Charge: $39.05 | ||