DIALYVITE 800-ULTRA D TABLET

Drug Details

General

Brand Name: DIALYVITE 800-ULTRA D TABLET
Generic Name: folic ac/vit Bcomp,C/Zn/vit D3
Manufacturer: HILLESTAD PHARM
NDC: 10542002509
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

Retail Pharmacy Cost: .13371
Retail Pharmacy Eff Date: 06/01/2016
Specialty Pharmacy Cost: .12552
Specialty Pharmacy Eff Date: 06/01/2016
Long-term Care Pharmacy Cost: .1318
Long-term Care Pharmacy Eff Date: 06/01/2016
340B Cost: .05866
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Compound-only use: No

CHIP

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

KHC

Effective date: 09/01/2020