DRESSING FOAM WITH SILICONE

DRESSING FOAM WITH SILICONE (10017F)

dressing foam with silicone 10.3 cm x 10.3 cm dressing, 10
10017F
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life 66801067 DPMQ: $74.94 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE (10021K)

dressing foam with silicone 21 cm x 21 cm dressing, 10
10021K
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life 66801070 DPMQ: $293.91 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE (10023M)

dressing foam with silicone 15.4 cm x 15.4 cm dressing, 10
10023M
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life 66801069 DPMQ: $146.10 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE (10029W)

dressing foam with silicone 12.9 cm x 12.9 cm dressing, 10
10029W
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life 66801068 DPMQ: $105.55 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE (11384E)

dressing foam with silicone 10.5 cm x 10.5 cm dressing, 10
11384E
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life Non-Bordered 66801748 DPMQ: $69.84 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE (11393P)

dressing foam with silicone 16 cm x 16 cm dressing, 10
11393P
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Life Non-Bordered 66801749 DPMQ: $118.71 Max safety net: $7.70 General Patient Charge: $7.70