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 | $11,775.03 | $25.00 | $25.00 |
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 | $11,984.25 | $25.00 | $25.00 |
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 | $11,984.25 | $25.00 | $25.00 |
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 | $11,775.03 | $25.00 | $25.00 |
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 | $11,984.25 | $25.00 | $25.00 |
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 | $11,775.03 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15065XMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 15 | $11,775.03 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15066YMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 5 | $11,984.25 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15072GMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 5 | $11,775.03 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15077MMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 15 | $11,775.03 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15093JMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 15 | $11,984.25 | $25.00 | $25.00 |
DARATUMUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 15094KMP | DARATUMUMAB Injection (PI, CMI)
|
1920 mg | 15 | $11,984.25 | $25.00 | $25.00 |
- Legend
- MPMedical Practitioner




