Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
10981YMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial (PI, CMI)	4	4	0	$958.49	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
10982BMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial (PI, CMI)	4	4	0	$958.49	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
10987GMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial (PI, CMI)	4	4	0	$958.49	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
10988HMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial (PI, CMI)	2	2	0	$855.69	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11006GMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial (PI, CMI)	2	2	0	$855.69	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11007HMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial (PI, CMI)	4	4	0	$958.49	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11015RMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial (PI, CMI)	2	2	0	$855.69	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11022DMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial (PI, CMI)	2	2	0	$855.69	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11831QMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 300 units injection, 1 vial (PI, CMI)	5	5	0	$1190.32	$31.60	$31.60
	Available brands
	Dysport

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11857CMP	CLOSTRIDIUM BOTULINUM TYPE A TOXIN-HAEMAGGLUTININ COMPLEX clostridium botulinum type A toxin-haemagglutinin complex 500 units injection, 1 vial (PI, CMI)	3	3	0	$1270.47	$31.60	$31.60
	Available brands
	Dysport