HYDROMORPHONE

hydromorphone hydrochloride 4 mg tablet, 20

HYDROMORPHONE (12032G)

hydromorphone hydrochloride 4 mg tablet, 20
12032G
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 0.5 Max qty units: 10 # of repeats: 0 DPMQ: $26.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilaudid