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
13002HMP	DRESSING CONTACT LAYER LIPIDOCOLLOID WITH SUCROSE OCTASULFATER dressing contact layer lipidocolloid with sucrose octasulfate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Contact-Interface-Tul 100380	1	1	3	$124.55	$7.30	$7.30

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
13011TMP	DRESSING CONTACT LAYER LIPIDOCOLLOID WITH SUCROSE OCTASULFATER dressing contact layer lipidocolloid with sucrose octasulfate 15 cm x 20 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Contact-Interface-Tul 100381	1	1	3	$228.23	$7.30	$7.30