NIZATIDINE

NIZATIDINE (14306Y)

nizatidine 150 mg capsule, 60
14306Y
Body System:
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: 120 # of repeats: 5 DPMQ: $34.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nizac
Tacidine
Tazac
*Additional charge for this brand is $15.18
 DPMQ: $49.86 Max safety net: $25.00 General Patient Charge: $40.18

NIZATIDINE (14372K)

nizatidine 300 mg capsule, 30
14372K
Body System:
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: 60 # of repeats: 5 DPMQ: $34.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nizac
Tacidine
Tazac
*Additional charge for this brand is $15.18
 DPMQ: $49.86 Max safety net: $25.00 General Patient Charge: $40.18

NIZATIDINE (1504E)

nizatidine 300 mg capsule, 30
1504E
Body System:
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: 30 # of repeats: 5 DPMQ: $24.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nizac
Tacidine
Tazac
*Additional charge for this brand is $7.59
 DPMQ: $31.82 Max safety net: $25.00 General Patient Charge: $32.59

NIZATIDINE (1505F)

nizatidine 150 mg capsule, 60
1505F
Body System:
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: 60 # of repeats: 5 DPMQ: $24.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nizac
Tacidine
Tazac
*Additional charge for this brand is $7.59
 DPMQ: $31.82 Max safety net: $25.00 General Patient Charge: $32.59