ALAHIST DM LIQUID

Drug Details

General

Brand Name: ALAHIST DM LIQUID
Generic Name: d-methorphan/pe/dexbromphenir
Manufacturer: POLY PHARMACEUT
NDC: 50991082616
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: .05073
Retail Pharmacy Eff Date: 03/16/2021
Specialty Pharmacy Cost: .04762
Specialty Pharmacy Eff Date: 03/16/2021
Long-term Care Pharmacy Cost: .05
Long-term Care Pharmacy Eff Date: 03/16/2021
340B Cost: .02226
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Effective date: 12/13/2016
Compound-only use: No

CHIP

Compound-only use: No

CSHCN

Effective date: 12/13/2016
Compound-only use: No