POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 28 x 0.8 mL unit doses

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL (15320H)

polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 28 x 0.8 mL unit doses
15320H
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required (STREAMLINED)

Restriction  15559

Indication: Severe dry eye syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $52.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Systane