VALACICLOVIR

valaciclovir 500 mg tablet, 100

VALACICLOVIR (9568N)

valaciclovir 500 mg tablet, 100
9568N
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction  5975

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
Max qty packs: 5 Max qty units: 500 # of repeats: 2 DPMQ: $200.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Valaciclovir
Valaciclovir RBX
Valtrex
*Additional charge for this brand is $13.50
 DPMQ: $213.50 Max safety net: $25.00 General Patient Charge: $38.50