DRESSING FOAM WITH SILICONE

Source Repatriation Pharmaceutical Benefits
Body System VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS
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
10017FMP DRESSING FOAM WITH SILICONER
dressing foam with silicone 10.3 cm x 10.3 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Life 66801067 1 1 0 $63.37 $6.60 $6.60
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DRESSING FOAM WITH SILICONE

Source Repatriation Pharmaceutical Benefits
Body System VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS
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
10021KMP DRESSING FOAM WITH SILICONER
dressing foam with silicone 21 cm x 21 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Life 66801070 1 1 0 $246.44 $6.60 $6.60
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DRESSING FOAM WITH SILICONE

Source Repatriation Pharmaceutical Benefits
Body System VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS
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
10023MMP DRESSING FOAM WITH SILICONER
dressing foam with silicone 15.4 cm x 15.4 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Life 66801069 1 1 0 $122.32 $6.60 $6.60
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DRESSING FOAM WITH SILICONE

Source Repatriation Pharmaceutical Benefits
Body System VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS
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
10029WMP DRESSING FOAM WITH SILICONER
dressing foam with silicone 12.9 cm x 12.9 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Life 66801068 1 1 0 $89.07 $6.60 $6.60
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  • Legend
  • RRepatriation Care items
  • MPMedical Practitioner