Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

Note

Authority Required (STREAMLINED)

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
5617PMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule (PI, CMI)	10	10	0	$762.70	$31.60	$31.60
	Available brands
	Bacthecala
	Lioresal Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

Note

Authority Required (STREAMLINED)

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
6284RMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule (PI, CMI)	10	10	0	$801.57	$31.60	$31.60
	Available brands
	Bacthecala
	Lioresal Intrathecala