HYDROCHLOROTHIAZIDE

hydrochlorothiazide 25 mg tablet, 100
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 1 DPMQ: $30.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dithiazide
hydrochlorothiazide 25 mg tablet, 100
Manner of administration:Oral
General Schedule
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: 100 # of repeats: 1 DPMQ: $21.94 Max safety net: $23.42 General Patient Charge: $25.00
Available brands
Dithiazide