VALACICLOVIR
Manner of administration:Oral
Restriction (Streamlined authority code: 5960)
Indication: Initial moderate to severe genital herpes
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 20 | # of repeats: 0 | DPMQ: $22.40 | Max safety net: $23.88 | General Patient Charge: $25.00 |
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DPMQ: $27.80 | Max safety net: $23.88 | General Patient Charge: $30.40 | ||