DRESSING FOAM WITH SILVER

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
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 $153.33 $6.60 $6.60
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DRESSING FOAM WITH SILVER

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
4255YMP DRESSING FOAM WITH SILVERR
dressing foam with silver 10 cm x 10 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Ag Adhesive 66800075 1 1 0 $228.11 $6.60 $6.60
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DRESSING FOAM WITH SILVER

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
4258DMP DRESSING FOAM WITH SILVERR
dressing foam with silver 12.5 cm x 12.5 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Ag Adhesive 66800078 1 1 0 $283.40 $6.60 $6.60
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DRESSING FOAM WITH SILVER

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
4259EMP DRESSING FOAM WITH SILVERR
dressing foam with silver 10 cm x 10 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Ag Non-Adhesive 66800086 1 1 0 $232.50 $6.60 $6.60
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DRESSING FOAM WITH SILVER

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
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 $153.33 $6.60 $6.60
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DRESSING FOAM WITH SILVER

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
4266MMP DRESSING FOAM WITH SILVERR
dressing foam with silver 10 cm x 10 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Ag Gentle Border 66800461 1 1 0 $228.11 $6.60 $6.60
space

DRESSING FOAM WITH SILVER

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
4270RMP DRESSING FOAM WITH SILVERR
dressing foam with silver 12.5 cm x 12.5 cm dressing, 10 (PI, CMI)
Available brands
Allevyn Ag Gentle Border 66800462 1 1 0 $283.40 $6.60 $6.60
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  • Legend
  • RRepatriation Care items
  • MPMedical Practitioner