LEVOTHYROXINE

levothyroxine sodium 100 microgram tablet, 200

LEVOTHYROXINE (2175L)

levothyroxine sodium 100 microgram tablet, 200
2175L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: For prescribing by certain health practitioners
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 200 # of repeats: 1 DPMQ: $22.06 Max safety net: $23.60 General Patient Charge: $25.00
Available brands
APO-Levothyroxine
Eltroxin
Eutroxsig
Levothox
Levothyroxine Lup
Levothyroxine Sandoz
Oroxine
*Additional charge for this brand is $0.96
 DPMQ: $23.02 Max safety net: $23.60 General Patient Charge: $25.96