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

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
12777LMP	DRESSING FOAM WITH SILICONE MODERATE EXUDATER dressing foam with silicone moderate exudate 4 cm x 5 cm dressing, 10 (PI, CMI)
	Available brands
	Mepilex Border Flex Lite 581011	1	1	0	$29.38	$7.70	$7.70