ETRAVIRINE

etravirine 200 mg tablet, 60
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5014)

Indication: HIV infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $819.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Intelence