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 | $11,190.83 | $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 | $11,391.90 | $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 | $11,391.90 | $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 | $11,190.83 | $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 | $11,391.90 | $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 | $11,190.83 | $25.00 | $25.00 |
- Legend
- MPMedical Practitioner




