DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
02207621 | ACYCLOVIR | APO-ACYCLOVIR 200 MG ORAL TABLET |
0.3511 TAB |
APX | 0.3511 | N/A | YES | REGULAR BENEFIT | |
02524708 | ACYCLOVIR | MINT-ACYCLOVIR 200 MG ORAL TABLET |
0.3511 TAB |
MPI | 0.3511 | N/A | YES | REGULAR BENEFIT | |
02242784 | ACYCLOVIR | MYLAN-ACYCLOVIR 200 MG ORAL TABLET |
0.3511 TAB |
MYP | 0.3511 | N/A | YES | REGULAR BENEFIT | |
02285959 | ACYCLOVIR | TEVA-ACYCLOVIR 200 MG ORAL TABLET |
0.3511 TAB |
TEV | 0.3511 | N/A | YES | REGULAR BENEFIT | |
00886157 | ACYCLOVIR | ZOVIRAX 40 MG / ML ORAL SUSPENSION |
0.2831 ML |
GSK | N/A | N/A | NO | REGULAR BENEFIT | |
02207648 | ACYCLOVIR | APO-ACYCLOVIR 400 MG ORAL TABLET |
0.8890 TAB |
APX | 0.8890 | N/A | YES | REGULAR BENEFIT | |
02524716 | ACYCLOVIR | MINT-ACYCLOVIR 400 MG ORAL TABLET |
0.8890 TAB |
MPI | 0.8890 | N/A | YES | REGULAR BENEFIT | |
02242463 | ACYCLOVIR | MYLAN-ACYCLOVIR 400 MG ORAL TABLET |
0.8890 TAB |
MYP | 0.8890 | N/A | YES | REGULAR BENEFIT | |
02285967 | ACYCLOVIR | TEVA-ACYCLOVIR 400 MG ORAL TABLET |
0.8890 TAB |
TEV | 0.8890 | N/A | YES | REGULAR BENEFIT | |
02207656 | ACYCLOVIR | APO-ACYCLOVIR 800 MG ORAL TABLET |
1.2673 TAB |
APX | 1.2673 | N/A | YES | REGULAR BENEFIT | |
02524724 | ACYCLOVIR | MINT-ACYCLOVIR 800 MG ORAL TABLET |
1.2673 TAB |
MPI | 1.2673 | N/A | YES | REGULAR BENEFIT | |
02242464 | ACYCLOVIR | MYLAN-ACYCLOVIR 800 MG ORAL TABLET |
1.2673 TAB |
MYP | 1.2673 | N/A | YES | REGULAR BENEFIT | |
02285975 | ACYCLOVIR | TEVA-ACYCLOVIR 800 MG ORAL TABLET |
1.2673 TAB |
TEV | 1.2673 | N/A | YES | REGULAR BENEFIT | |
02420333 | ADEFOVIR DIPIVOXIL | AA-ADEFOVIR 10 MG ORAL TABLET |
18.2518 TAB |
AAP | 0.0000 | 0.0000 | NO | RESTRICTED BENEFIT | |
02479907 | ENTECAVIR | ACCEL-ENTECAVIR 0.5 MG ORAL TABLET |
4.4000 TAB |
ACP | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02396955 | ENTECAVIR | APO-ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
APX | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02448777 | ENTECAVIR | AURO-ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
AUR | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02282224 | ENTECAVIR | BARACLUDE 0.5 MG ORAL TABLET |
22.6600 TAB |
BMS | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02527154 | ENTECAVIR | ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
SNS | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02467232 | ENTECAVIR | JAMP-ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
JPC | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02485907 | ENTECAVIR | MINT-ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
MPI | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02430576 | ENTECAVIR | PMS-ENTECAVIR 0.5 MG ORAL TABLET |
5.5000 TAB |
PMS | 4.4000 | N/A | YES | RESTRICTED BENEFIT | |
02292068 | FAMCICLOVIR | APO-FAMCICLOVIR 500 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | NO | NOT A BENEFIT | |
02278650 | FAMCICLOVIR | SANDOZ FAMCICLOVIR 500 MG ORAL TABLET |
N/A TAB |
SDZ | N/A | N/A | NO | NOT A BENEFIT | |
02162695 | GANCICLOVIR SODIUM | CYTOVENE 500 MG / VIAL INJECTION |
48.5996 VIAL |
CAG | N/A | N/A | NO | REGULAR BENEFIT | |
02439212 | RIBAVIRIN | IBAVYR 200 MG ORAL TABLET |
12.2399 TAB |
PPH | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02354705 | VALACYCLOVIR | APO-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
1.7218 TAB |
APX | 1.7218 | N/A | YES | REGULAR BENEFIT | |
02351560 | VALACYCLOVIR | MYLAN-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
1.7218 TAB |
MYP | 1.7218 | N/A | YES | REGULAR BENEFIT | |
02381230 | VALACYCLOVIR | PMS-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
1.7218 TAB |
PMS | 1.7218 | N/A | YES | REGULAR BENEFIT | |
02519585 | VALACYCLOVIR | VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
1.7218 TAB |
SNS | 1.7218 | N/A | YES | REGULAR BENEFIT | |
02295822 | VALACYCLOVIR | APO-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
0.6198 TAB |
APX | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02405040 | VALACYCLOVIR | AURO-VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
AUR | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02440598 | VALACYCLOVIR | JAMP-VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
JPC | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02441454 | VALACYCLOVIR | JAMP-VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
JPC | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02351579 | VALACYCLOVIR | MYLAN-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
0.6198 TAB |
MYP | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02298457 | VALACYCLOVIR | PMS-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
0.6198 TAB |
PMS | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02347091 | VALACYCLOVIR | SANDOZ VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
SDZ | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02357534 | VALACYCLOVIR | TEVA-VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
TEV | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02442000 | VALACYCLOVIR | VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
SIV | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02454645 | VALACYCLOVIR | VALACYCLOVIR 500 MG ORAL TABLET |
0.6198 TAB |
SNS | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02219492 | VALACYCLOVIR | VALTREX (CAPLET) 500 MG ORAL TABLET |
3.8882 TAB |
GSK | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02435179 | VALGANCICLOVIR HCL | AURO-VALGANCICLOVIR 450 MG ORAL TABLET |
5.8553 TAB |
AUR | 5.8553 | N/A | YES | REGULAR BENEFIT | |
02495457 | VALGANCICLOVIR HCL | MINT-VALGANCICLOVIR 450 MG ORAL TABLET |
5.8553 TAB |
MPI | 5.8553 | N/A | YES | REGULAR BENEFIT | |
02413825 | VALGANCICLOVIR HCL | TEVA-VALGANCICLOVIR 450 MG ORAL TABLET |
5.8553 TAB |
TEV | 5.8553 | N/A | YES | REGULAR BENEFIT | |
02245777 | VALGANCICLOVIR HCL | VALCYTE 450 MG ORAL TABLET |
26.9559 TAB |
CAG | 5.8553 | N/A | YES | REGULAR BENEFIT | |
02535483 | VALGANCICLOVIR HCL | AURO-VALGANCICLOVIR 50 MG / ML ORAL SUSPENSION |
1.5099 ML |
AUR | 2.0589 | N/A | YES | REGULAR BENEFIT | |
02306085 | VALGANCICLOVIR HCL | VALCYTE 50 MG / ML ORAL SUSPENSION |
2.9949 ML |
CAG | 2.0589 | N/A | YES | REGULAR BENEFIT |
DIN/NPN/ PIN | 02207621 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | APO-ACYCLOVIR 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3511 |
Manufacturer | APX |
LCA Price | 0.3511 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02524708 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MINT-ACYCLOVIR 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3511 |
Manufacturer | MPI |
LCA Price | 0.3511 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02242784 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MYLAN-ACYCLOVIR 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3511 |
Manufacturer | MYP |
LCA Price | 0.3511 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02285959 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | TEVA-ACYCLOVIR 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3511 |
Manufacturer | TEV |
LCA Price | 0.3511 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00886157 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | ZOVIRAX 40 MG / ML ORAL SUSPENSION |
Unit Price, Unit of Issue | 0.2831 |
Manufacturer | GSK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02207648 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | APO-ACYCLOVIR 400 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8890 |
Manufacturer | APX |
LCA Price | 0.8890 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02524716 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MINT-ACYCLOVIR 400 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8890 |
Manufacturer | MPI |
LCA Price | 0.8890 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02242463 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MYLAN-ACYCLOVIR 400 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8890 |
Manufacturer | MYP |
LCA Price | 0.8890 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02285967 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | TEVA-ACYCLOVIR 400 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8890 |
Manufacturer | TEV |
LCA Price | 0.8890 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02207656 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | APO-ACYCLOVIR 800 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2673 |
Manufacturer | APX |
LCA Price | 1.2673 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02524724 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MINT-ACYCLOVIR 800 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2673 |
Manufacturer | MPI |
LCA Price | 1.2673 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02242464 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | MYLAN-ACYCLOVIR 800 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2673 |
Manufacturer | MYP |
LCA Price | 1.2673 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02285975 |
Generic Name | ACYCLOVIR |
Product Name, Strength & Dosage Form | TEVA-ACYCLOVIR 800 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2673 |
Manufacturer | TEV |
LCA Price | 1.2673 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02420333 |
Generic Name | ADEFOVIR DIPIVOXIL |
Product Name, Strength & Dosage Form | AA-ADEFOVIR 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 18.2518 |
Manufacturer | AAP |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02479907 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | ACCEL-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 4.4000 |
Manufacturer | ACP |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02396955 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | APO-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | APX |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02448777 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | AURO-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | AUR |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02282224 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | BARACLUDE 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 22.6600 |
Manufacturer | BMS |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02527154 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | SNS |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02467232 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | JAMP-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | JPC |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02485907 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | MINT-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | MPI |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02430576 |
Generic Name | ENTECAVIR |
Product Name, Strength & Dosage Form | PMS-ENTECAVIR 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.5000 |
Manufacturer | PMS |
LCA Price | 4.4000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02292068 |
Generic Name | FAMCICLOVIR |
Product Name, Strength & Dosage Form | APO-FAMCICLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02278650 |
Generic Name | FAMCICLOVIR |
Product Name, Strength & Dosage Form | SANDOZ FAMCICLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02162695 |
Generic Name | GANCICLOVIR SODIUM |
Product Name, Strength & Dosage Form | CYTOVENE 500 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 48.5996 |
Manufacturer | CAG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02439212 |
Generic Name | RIBAVIRIN |
Product Name, Strength & Dosage Form | IBAVYR 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 12.2399 |
Manufacturer | PPH |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02354705 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | APO-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7218 |
Manufacturer | APX |
LCA Price | 1.7218 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02351560 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | MYLAN-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7218 |
Manufacturer | MYP |
LCA Price | 1.7218 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02381230 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | PMS-VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7218 |
Manufacturer | PMS |
LCA Price | 1.7218 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02519585 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | VALACYCLOVIR (CAPLET) 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7218 |
Manufacturer | SNS |
LCA Price | 1.7218 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02295822 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | APO-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | APX |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02405040 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | AURO-VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | AUR |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02440598 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | JAMP-VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | JPC |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02441454 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | JAMP-VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | JPC |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02351579 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | MYLAN-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | MYP |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02298457 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | PMS-VALACYCLOVIR (CAPLET) 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | PMS |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02347091 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | SANDOZ VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | SDZ |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02357534 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | TEVA-VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | TEV |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02442000 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | SIV |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02454645 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | VALACYCLOVIR 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6198 |
Manufacturer | SNS |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02219492 |
Generic Name | VALACYCLOVIR |
Product Name, Strength & Dosage Form | VALTREX (CAPLET) 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 3.8882 |
Manufacturer | GSK |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02435179 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | AURO-VALGANCICLOVIR 450 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.8553 |
Manufacturer | AUR |
LCA Price | 5.8553 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02495457 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | MINT-VALGANCICLOVIR 450 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.8553 |
Manufacturer | MPI |
LCA Price | 5.8553 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02413825 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | TEVA-VALGANCICLOVIR 450 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.8553 |
Manufacturer | TEV |
LCA Price | 5.8553 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02245777 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | VALCYTE 450 MG ORAL TABLET |
Unit Price, Unit of Issue | 26.9559 |
Manufacturer | CAG |
LCA Price | 5.8553 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02535483 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | AURO-VALGANCICLOVIR 50 MG / ML ORAL SUSPENSION |
Unit Price, Unit of Issue | 1.5099 |
Manufacturer | AUR |
LCA Price | 2.0589 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02306085 |
Generic Name | VALGANCICLOVIR HCL |
Product Name, Strength & Dosage Form | VALCYTE 50 MG / ML ORAL SUSPENSION |
Unit Price, Unit of Issue | 2.9949 |
Manufacturer | CAG |
LCA Price | 2.0589 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |