Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
4590NMP	DRESSING FOAM MODERATE EXUDATER dressing foam moderate exudate 12.5 cm x 12.5 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Adhesive 66000044	1	1	0	$168.81	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
4694CMP	DRESSING FOAM MODERATE EXUDATER dressing foam moderate exudate cavity conforming foam, 20 g sachet (PI, CMI)
	Available brands
	Cavicare 4563	1	1	1	$100.82	$7.70	$7.70