Source	Section 100 (CT)
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER 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
1899YMP	FOLINIC ACID folinic acid 50 mg/5 mL injection, 10 x 5 mL ampoules (PI, CMI)	1	10	2	$38.90	$31.60	$31.60
	Available brands
	Leucovorin Calcium (Pfizer Australia Pty Ltd)

Source	Section 100 (CT)
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER 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
1904FMP	FOLINIC ACID folinic acid 100 mg/10 mL injection, 10 x 10 mL ampoules (PI, CMI)	1	10	1	$43.80	$31.60	$31.60
	Available brands
	Leucovorin Calcium (Pfizer Australia Pty Ltd)

Source	Section 100 (CT)
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER 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
5904RMP	FOLINIC ACID folinic acid 15 mg tablet, 10 (PI, CMI)	1	10	0	$76.00	$31.60	$31.60
	Available brands
	Leucovorin Calcium (Hospira Pty Limited)