VALACICLOVIR

VALACICLOVIR (5480K)

valaciclovir 500 mg tablet, 30
5480K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5940)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Suppressive therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $26.69 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Valaciclovir
Shilova 500
VALACICLOVIR-WGR
Vaclovir
Valaciclovir RBX
Valaciclovir SZ
Valaciclovir Sandoz
Zelitrex
Valtrex
*Additional charge for this brand is $2.43
 DPMQ: $29.12 Max safety net: $25.00 General Patient Charge: $27.43

VALACICLOVIR (8134D)

valaciclovir 500 mg tablet, 30
8134D
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5961)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Episodic treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $26.69 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Valaciclovir
Shilova 500
VALACICLOVIR-WGR
Vaclovir
Valaciclovir RBX
Valaciclovir SZ
Valaciclovir Sandoz
Zelitrex
Valtrex
*Additional charge for this brand is $2.43
 DPMQ: $29.12 Max safety net: $25.00 General Patient Charge: $27.43