Displaying 1 - 50 of 135 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACYCLOVIR 200 MG CAPSULE
acyclovir
69076014601 No No
ACYCLOVIR 200 MG CAPSULE
acyclovir
00904578961 No No
ACYCLOVIR 200 MG CAPSULE
acyclovir
75834012401 No No
ACYCLOVIR 200 MG CAPSULE
acyclovir
23155022901 No No
ACYCLOVIR 200 MG CAPSULE
acyclovir
23155022905 No No
ACYCLOVIR 200 MG CAPSULE
acyclovir
60505004206 No No
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
00378871273 No No
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
00472008216 No No
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
50383081016 No No
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
70954018810 No No
ACYCLOVIR 400 MG TABLET
acyclovir
61442011201 No No
ACYCLOVIR 400 MG TABLET
acyclovir
61442011205 No No
ACYCLOVIR 400 MG TABLET
acyclovir
31722077701 No No
ACYCLOVIR 400 MG TABLET
acyclovir
31722077705 No No
ACYCLOVIR 400 MG TABLET
acyclovir
00904579061 No No
ACYCLOVIR 400 MG TABLET
acyclovir
69117001801 No No
ACYCLOVIR 400 MG TABLET
acyclovir
69117001802 No No
ACYCLOVIR 400 MG TABLET
acyclovir
63739068210 No No
ACYCLOVIR 400 MG TABLET
acyclovir
23155022701 No No
ACYCLOVIR 400 MG TABLET
acyclovir
23155022705 No No
ACYCLOVIR 400 MG TABLET
acyclovir
68382079101 No No
ACYCLOVIR 400 MG TABLET
acyclovir
68382079105 No No
ACYCLOVIR 400 MG TABLET
acyclovir
60505530601 No No
ACYCLOVIR 400 MG TABLET
acyclovir
60505530608 No No
ACYCLOVIR 800 MG TABLET
acyclovir
60505530701 No No
ACYCLOVIR 800 MG TABLET
acyclovir
60505530705 No No
ACYCLOVIR 800 MG TABLET
acyclovir
61442011301 No No
ACYCLOVIR 800 MG TABLET
acyclovir
61442011305 No No
ACYCLOVIR 800 MG TABLET
acyclovir
31722077801 No No
ACYCLOVIR 800 MG TABLET
acyclovir
31722077805 No No
ACYCLOVIR 800 MG TABLET
acyclovir
69117001901 No No
ACYCLOVIR 800 MG TABLET
acyclovir
69117001902 No No
ACYCLOVIR 800 MG TABLET
acyclovir
23155022801 No No
ACYCLOVIR 800 MG TABLET
acyclovir
23155022805 No No
ACYCLOVIR 800 MG TABLET
acyclovir
68382079201 No No
ACYCLOVIR 800 MG TABLET
acyclovir
68382079205 No No
FAMCICLOVIR 125 MG TABLET
famciclovir
31722070630 No No
FAMCICLOVIR 125 MG TABLET
famciclovir
33342002407 No No
FAMCICLOVIR 125 MG TABLET
famciclovir
16714061401 No No
FAMCICLOVIR 125 MG TABLET
famciclovir
00093811756 No No
FAMCICLOVIR 125 MG TABLET
famciclovir
60505324503 No No
FAMCICLOVIR 250 MG TABLET
famciclovir
31722070730 No No
FAMCICLOVIR 250 MG TABLET
famciclovir
33342002507 No No
FAMCICLOVIR 250 MG TABLET
famciclovir
16714061501 No No
FAMCICLOVIR 250 MG TABLET
famciclovir
00093811856 No No
FAMCICLOVIR 250 MG TABLET
famciclovir
60505324603 No No
FAMCICLOVIR 500 MG TABLET
famciclovir
31722070830 No No
FAMCICLOVIR 500 MG TABLET
famciclovir
33342002607 No No
FAMCICLOVIR 500 MG TABLET
famciclovir
16714061601 No No
FAMCICLOVIR 500 MG TABLET
famciclovir
00093811956 No No