ACICLOVIR
aciclovir 200 mg tablet, 25
ACICLOVIR (1003T)
1003T
Manner of administration:Oral
Restriction 5936
Indication: Initial moderate to severe genital herpes
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 50 | # of repeats: 0 | DPMQ: $23.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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