SERTRALINE

SERTRALINE (14400X)

sertraline 50 mg tablet, 30
14400X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: 2 DPMQ: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 50
SERTRALINE-WGR
Sertra 50
Sertraline Sandoz
Sertraline generichealth
Setrona
Zoloft
*Additional charge for this brand is $12.94
 DPMQ: $32.78 Max safety net: $21.38 General Patient Charge: $37.11

SERTRALINE (14403C)

sertraline 50 mg tablet, 30
14403C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Obsessive-compulsive disorder

Restriction

Indication: Panic disorder
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: 2 DPMQ: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 50
SERTRALINE-WGR
Sertra 50
Sertraline Sandoz
Sertraline generichealth
Zoloft
*Additional charge for this brand is $12.94
 DPMQ: $32.78 Max safety net: $21.38 General Patient Charge: $37.11

SERTRALINE (14404D)

sertraline 100 mg tablet, 30
14404D
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Obsessive-compulsive disorder

Restriction

Indication: Panic disorder
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: 2 DPMQ: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 100
SERTRALINE-WGR
Sertra 100
Sertraline Sandoz
Sertraline generichealth
Zoloft
*Additional charge for this brand is $12.94
 DPMQ: $32.78 Max safety net: $21.38 General Patient Charge: $37.11

SERTRALINE (14506L)

sertraline 100 mg tablet, 30
14506L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: 2 DPMQ: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 100
SERTRALINE-WGR
Sertra 100
Sertraline Sandoz
Sertraline generichealth
Setrona
Zoloft
*Additional charge for this brand is $12.94
 DPMQ: $32.78 Max safety net: $21.38 General Patient Charge: $37.11

SERTRALINE (2236Q)

sertraline 50 mg tablet, 30
2236Q
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 50
SERTRALINE-WGR
Sertra 50
Sertraline Sandoz
Sertraline generichealth
Setrona
Zoloft
*Additional charge for this brand is $6.47
 DPMQ: $23.57 Max safety net: $18.64 General Patient Charge: $27.90

SERTRALINE (2237R)

sertraline 100 mg tablet, 30
2237R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 100
SERTRALINE-WGR
Sertra 100
Sertraline Sandoz
Sertraline generichealth
Setrona
Zoloft
*Additional charge for this brand is $6.47
 DPMQ: $23.57 Max safety net: $18.64 General Patient Charge: $27.90

SERTRALINE (8836C)

sertraline 50 mg tablet, 30
8836C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Obsessive-compulsive disorder

Restriction

Indication: Panic disorder
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 50
SERTRALINE-WGR
Sertra 50
Sertraline Sandoz
Sertraline generichealth
Zoloft
*Additional charge for this brand is $6.47
 DPMQ: $23.57 Max safety net: $18.64 General Patient Charge: $27.90

SERTRALINE (8837D)

sertraline 100 mg tablet, 30
8837D
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Obsessive-compulsive disorder

Restriction

Indication: Panic disorder
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Sertraline
Blooms The Chemist Sertraline
Eleva 100
SERTRALINE-WGR
Sertra 100
Sertraline Sandoz
Sertraline generichealth
Zoloft
*Additional charge for this brand is $6.47
 DPMQ: $23.57 Max safety net: $18.64 General Patient Charge: $27.90