ESOMEPRAZOLE (&) CLARITHROMYCIN (&) AMOXICILLIN

ESOMEPRAZOLE (&) CLARITHROMYCIN (&) AMOXICILLIN (10759G)

esomeprazole 20 mg enteric tablet [14] (&) amoxicillin 500 mg capsule [28] (&) clarithromycin 500 mg tablet [14], 1 pack
10759G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Eradication of Helicobacter pylori
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: $36.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ESOMEPRAZOLE SANDOZ Hp7

ESOMEPRAZOLE (&) CLARITHROMYCIN (&) AMOXICILLIN (8738X)

esomeprazole 20 mg enteric tablet [14] (&) amoxicillin 500 mg capsule [28] (&) clarithromycin 500 mg tablet [14], 1 pack
8738X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Eradication of Helicobacter pylori
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
Nexium Hp7
*Additional charge for this brand is $4.96
 DPMQ: $41.00 Max safety net: $25.00 General Patient Charge: $29.96