ACYCLOVIR 200 MG/5 ML SUSP

Drug Details

General

Brand Name: ACYCLOVIR 200 MG/5 ML SUSP
Generic Name: acyclovir
Manufacturer: MYLAN
NDC: 00378871273
Package size: 473ML
Family Planning drug: No
Diabetic Supply Drug: No
HTW drug: No
HTWPlus drug: No
Long-acting reversible contraception product: No
Refill-to-soon Utilization*: 75%

Drug Pricing

Retail Pharmacy Cost: .36921
Retail Pharmacy Eff Date: 03/23/2021
Specialty Pharmacy Cost: .36274
Specialty Pharmacy Eff Date: 03/23/2021
Long-term Care Pharmacy Cost: .36034
Long-term Care Pharmacy Eff Date: 03/23/2021
340B Cost: .32378
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Effective date: 02/25/2019
PDL Class: ANTIVIRALS: ORAL
Compound-only use: No

CHIP

Effective date: 02/25/2019
Compound-only use: No

CSHCN

Effective date: 02/25/2019
Compound-only use: No

KHC

Effective date: 02/25/2019