PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10424PMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 7 | $7886.47 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10475HMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 5 | $7886.47 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11352LMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15641.03 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11492WMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 6 | $7886.47 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11632FMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15641.03 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12120XMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 7 | $7886.47 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12121YMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15641.03 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12122BMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 2 | $15641.03 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12123CMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15641.03 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12125EMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15641.03 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner