TRIMETHOPRIM

trimethoprim 300 mg tablet, 7

TRIMETHOPRIM (10785P)

trimethoprim 300 mg tablet, 7
10785P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Prostatitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 0 DPMQ: $25.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
TRIMETHOPRIM-WGR
Trimethoprim Viatris
Alprim
*Additional charge for this brand is $10.28
 DPMQ: $35.60 Max safety net: $25.00 General Patient Charge: $35.28
Triprim
*Additional charge for this brand is $14.92
 DPMQ: $40.24 Max safety net: $25.00 General Patient Charge: $39.92