Product Details

Mint-Acyclovir

Acyclovir
400 mg
Tablet


DIN/PIN/NPN

02524716

Manufacturer

Mint Pharmaceuticals Inc.

Formulary Listing Date

2022-10-31  

Unit Price

0.8890

Amount MOH Pays

0.8890

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

J05AB01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
01911627 Zovirax NA NA
02285967 Teva-Acyclovir 0.8890 0.8890
02242463 Mylan-Acyclovir 0.8890 0.8890
02207648 Apo-Acyclovir 0.8890 0.8890
02524716 Mint-Acyclovir 0.8890 0.8890
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph