Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

Authority Required

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
4252TMP	DRESSING FOAM WITH SILVERR dressing foam with silver 7.5 cm x 7.5 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Ag Adhesive 66800073	1	1	0	$173.71	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

Authority Required

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
4263JMP	DRESSING FOAM WITH SILVERR dressing foam with silver 7.5 cm x 7.5 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Ag Gentle Border 66800460	1	1	0	$173.71	$7.70	$7.70