PHENOXYMETHYLPENICILLIN

PHENOXYMETHYLPENICILLIN (13968E)

phenoxymethylpenicillin 250 mg capsule, 50
13968E
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: 100 # of repeats: 5 DPMQ: $22.50 Max safety net: $24.04 General Patient Charge: $25.00
Available brands
Cilicaine VK
LPV

PHENOXYMETHYLPENICILLIN (1705R)

phenoxymethylpenicillin 250 mg capsule, 50
1705R
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: 1 Max qty units: 50 # of repeats: 5 DPMQ: $18.43 Max safety net: $19.97 General Patient Charge: $22.76
Available brands
Cilicaine VK
LPV

PHENOXYMETHYLPENICILLIN (1789E)

phenoxymethylpenicillin 250 mg capsule, 50
1789E
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: 50 # of repeats: 0 DPMQ: $18.43 Max safety net: $19.97 General Patient Charge: $22.76
Available brands
Cilicaine VK
LPV

PHENOXYMETHYLPENICILLIN (3363B)

phenoxymethylpenicillin 250 mg capsule, 50
3363B
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: 50 # of repeats: 0 DPMQ: $18.43 Max safety net: $19.97 General Patient Charge: $22.76
Available brands
Cilicaine VK
LPV