DICLOXACILLIN

dicloxacillin 500 mg capsule, 24

DICLOXACILLIN (5097G)

dicloxacillin 500 mg capsule, 24
5097G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Serious staphylococcal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 24 # of repeats: 0 DPMQ: $22.21 Max safety net: $23.75 General Patient Charge: $25.00
Available brands
ARX-Dicloxacillin
DICLOXACILLIN VIATRIS 500
Distaph 500
*Additional charge for this brand is $1.90
 DPMQ: $24.11 Max safety net: $23.75 General Patient Charge: $26.90