AMOXICILLIN

AMOXICILLIN (12002Q)

amoxicillin 1 g tablet, 14
12002Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10416)

Indication: Community acquired pneumonia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 14 # of repeats: 1 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
Amoxycillin Sandoz
Maxamox
*Additional charge for this brand is $1.00
 DPMQ: $17.70 Max safety net: $18.18 General Patient Charge: $21.97

AMOXICILLIN (8581P)

amoxicillin 1 g tablet, 14
8581P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic bronchitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 14 # of repeats: 1 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
Amoxycillin Sandoz
Maxamox
*Additional charge for this brand is $1.00
 DPMQ: $17.70 Max safety net: $18.18 General Patient Charge: $21.97