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
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	$337.92	$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
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	$337.92	$7.70	$7.70