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
13017DMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE HEAVY EXUDATER dressing foam lipidocolloid with sucrose octasulfate heavy exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Border 100481	1	1	3	$166.86	$7.70	$7.70

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
13021HMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE HEAVY EXUDATER dressing foam lipidocolloid with sucrose octasulfate heavy exudate 15 cm x 20 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Border 100482	1	1	3	$363.96	$7.70	$7.70

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
13023KMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE HEAVY EXUDATER dressing foam lipidocolloid with sucrose octasulfate heavy exudate 8 cm x 8 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Border 100480	1	1	3	$129.29	$7.70	$7.70