SACUBITRIL + VALSARTAN
Manner of administration:Oral
Restriction (Streamlined authority code: 18150)
Indication: Chronic heart failure
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $100.59 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 18338)
Indication: Chronic heart failure
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $191.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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