BALSALAZIDE

BALSALAZIDE (11351K)

balsalazide sodium 750 mg capsule, 280
11351K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16658)

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 280 # of repeats: 5 DPMQ: $158.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Colazide

BALSALAZIDE (13484Q)

balsalazide sodium 750 mg capsule, 280
13484Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16551)

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 560 # of repeats: 5 DPMQ: $308.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Colazide