SERTRALINE

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: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
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 $13.56
 DPMQ: $32.78 Max safety net: $20.70 General Patient Charge: $37.05

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: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
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 $13.56
 DPMQ: $32.78 Max safety net: $20.70 General Patient Charge: $37.05

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: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
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 $6.78
 DPMQ: $23.28 Max safety net: $17.98 General Patient Charge: $27.55

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: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
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 $6.78
 DPMQ: $23.28 Max safety net: $17.98 General Patient Charge: $27.55