Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Restricted Benefit

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
12760NMP	DRESSING FOAM HEAVY EXUDATER dressing foam heavy exudate 10 cm x 10 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex XT 211100	1	1	0	$43.79	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Restricted Benefit

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
12776KMP	DRESSING FOAM HEAVY EXUDATER dressing foam heavy exudate 20 cm x 20 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex XT 211400	1	1	0	$131.39	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Restricted Benefit

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
12797MMP	DRESSING FOAM HEAVY EXUDATER dressing foam heavy exudate 5 cm x 5 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex XT 211015	1	1	0	$37.77	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
4795JMP	DRESSING FOAM HEAVY EXUDATER dressing foam heavy exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn 66007637	1	1	1	$170.04	$7.70	$7.70