DIDANOSINE DR 250 MG CAPSULE

Drug Details

General

Brand Name: DIDANOSINE DR 250 MG CAPSULE
Generic Name: didanosine
Manufacturer: AUROBINDO PHARM
NDC: 65862031230
Package size: 30EA
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: 5.55234
Retail Pharmacy Eff Date: 06/01/2016
Specialty Pharmacy Cost: 5.2124
Specialty Pharmacy Eff Date: 06/01/2016
Long-term Care Pharmacy Cost: 5.47302
Long-term Care Pharmacy Eff Date: 06/01/2016
340B Cost: 3.39939
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Effective date: 12/10/2008
PDL Class: HIV / AIDS
Compound-only use: No

CHIP

Effective date: 12/10/2008
Compound-only use: No

CSHCN

Effective date: 12/10/2008
Compound-only use: No
Comments: Refer to program requirements