DIALYVITE 3,000 TABLET

Drug Details

General

Brand Name: DIALYVITE 3,000 TABLET
Generic Name: folic acid/B cplx/C/selen/zinc
Manufacturer: HILLESTAD PHARM
NDC: 10542001409
Package size: 90EA
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

340B Cost: .1117
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Compound-only use: No

CHIP

Compound-only use: No
Compound-only use: No

KHC

Effective date: 09/15/2004