PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10436GMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 7 | $7736.12 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
10493GMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 5 | $7736.12 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11330HMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11494YMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 6 | $7736.12 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
11646YMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12119WMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12124DMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12127GMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 3 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12128HMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 2 | $15383.62 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
---|---|---|---|---|---|---|---|---|
12129JMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15383.62 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner