BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10166CMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $18708.62 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10171HMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $18708.62 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10172JMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10180TMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11067LMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11073TMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $18708.62 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11079DMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $18708.62 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11080EMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11086LMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11087MMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $18708.62 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11089PMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 3 | $19012.59 | $31.60 | $31.60 |
BRENTUXIMAB VEDOTIN
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11096BMP | BRENTUXIMAB VEDOTIN Injection (PI, CMI)
|
200 mg | 11 | $18708.62 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner