PHENOXYMETHYLPENICILLIN

PHENOXYMETHYLPENICILLIN (14044E)

phenoxymethylpenicillin 250 mg tablet, 25
14044E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Recurrent streptococcal infections (including rheumatic fever)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 100 # of repeats: 5 DPMQ: $30.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Aspecillin VK

PHENOXYMETHYLPENICILLIN (1703P)

phenoxymethylpenicillin 250 mg tablet, 25
1703P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Recurrent streptococcal infections (including rheumatic fever)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 5 DPMQ: $22.04 Max safety net: $23.52 General Patient Charge: $25.00
Available brands
Aspecillin VK

PHENOXYMETHYLPENICILLIN (1787C)

phenoxymethylpenicillin 250 mg tablet, 25
1787C
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: 2 Max qty units: 50 # of repeats: 0 DPMQ: $22.04 Max safety net: $23.52 General Patient Charge: $25.00
Available brands
Aspecillin VK

PHENOXYMETHYLPENICILLIN (3360W)

phenoxymethylpenicillin 250 mg tablet, 25
3360W
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: 2 Max qty units: 50 # of repeats: 0 DPMQ: $22.04 Max safety net: $23.52 General Patient Charge: $25.00
Available brands
Aspecillin VK