VALGANCICLOVIR

VALGANCICLOVIR (10306K)

valganciclovir 450 mg tablet, 60
10306K
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4980)

Indication: Cytomegalovirus retinitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $504.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Valganciclovir Sandoz
Valganciclovir Viatris

VALGANCICLOVIR (6357N)

valganciclovir 450 mg tablet, 60
6357N
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15784)

Indication: Cytomegalovirus infection and disease

Restriction (Streamlined authority code: 15782)

Indication: Cytomegalovirus infection and disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $504.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Valganciclovir Sandoz
Valganciclovir Viatris

VALGANCICLOVIR (9569P)

valganciclovir 450 mg tablet, 60
9569P
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15800)

Indication: Cytomegalovirus infection and disease

Restriction (Streamlined authority code: 15814)

Indication: Cytomegalovirus infection and disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $476.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Valganciclovir Sandoz
Valganciclovir Viatris