THEOPHYLLINE

THEOPHYLLINE (2614N)

theophylline 133.3 mg/25 mL oral liquid, 500 mL
2614N
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: 1 # of repeats: 5 DPMQ: $19.05 Max safety net: $20.59 General Patient Charge: $23.38
Available brands
Nuelin

THEOPHYLLINE (2634P)

theophylline 250 mg modified release tablet, 100
2634P
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: 100 # of repeats: 5 DPMQ: $19.58 Max safety net: $21.12 General Patient Charge: $23.91
Available brands
Nuelin-SR 250

THEOPHYLLINE (8230E)

theophylline 200 mg modified release tablet, 100
8230E
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: 100 # of repeats: 5 DPMQ: $18.75 Max safety net: $20.29 General Patient Charge: $23.08
Available brands
Nuelin-SR 200

THEOPHYLLINE (8231F)

theophylline 300 mg modified release tablet, 100
8231F
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: 100 # of repeats: 5 DPMQ: $20.62 Max safety net: $22.16 General Patient Charge: $24.95
Available brands
Nuelin-SR 300