MANNITOL

MANNITOL (2008Q)

mannitol 40 mg powder for inhalation, 280 capsules
2008Q
Body System:
Manner of administration:Inhalation By Mouth
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9527)

Indication: Cystic fibrosis

Restriction (Streamlined authority code: 9593)

Indication: Cystic fibrosis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $1,838.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bronchitol

MANNITOL (2015C)

mannitol 40 mg powder for inhalation, 280 capsules
2015C
Body System:
Manner of administration:Inhalation By Mouth
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7362)

Indication: Cystic fibrosis

Restriction (Streamlined authority code: 7367)

Indication: Cystic fibrosis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $1,789.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bronchitol