LAMIVUDINE

LAMIVUDINE (10315X)

lamivudine 100 mg tablet, 28
10315X
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4993)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 5036)

Indication: Chronic hepatitis B 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: 56 # of repeats: 5 DPMQ: $59.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zetlam
Zeffix
*Additional charge for this brand is $2.36
 DPMQ: $62.12 Max safety net: $25.00 General Patient Charge: $27.36