DRESSING FOAM WITH SILICONE MODERATE EXUDATE

DRESSING FOAM WITH SILICONE MODERATE EXUDATE (12777L)

dressing foam with silicone moderate exudate 4 cm x 5 cm dressing, 10
12777L
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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
Mepilex Border Flex Lite 581011 DPMQ: $29.38 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE MODERATE EXUDATE (12782R)

dressing foam with silicone moderate exudate 5 cm x 12.5 cm dressing, 5
12782R
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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
Mepilex Border Flex Lite 581100 DPMQ: $32.07 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE MODERATE EXUDATE (12799P)

dressing foam with silicone moderate exudate 10 cm x 10 cm dressing, 5
12799P
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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
Mepilex Border Flex Lite 581300 DPMQ: $38.68 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILICONE MODERATE EXUDATE (4626L)

dressing foam with silicone moderate exudate 10 cm x 10 cm dressing, 5
4626L
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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
Mepilex 294100 DPMQ: $45.55 Max safety net: $7.70 General Patient Charge: $7.70