DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12220EMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 4 | $11770.87 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12221FMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 7 | $11976.05 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12225KMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 4 | $11976.05 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12226LMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 5 | $11976.05 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12228NMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 8 | $11770.87 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12229PMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 7 | $11770.87 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12230QMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 8 | $11976.05 | $30.00 | $30.00 |
DARATUMUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
12231RMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 5 | $11770.87 | $30.00 | $30.00 |
- Legend
- MPMedical Practitioner