VANCOMYCIN
Manner of administration:Injection
Restriction
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 5 | Max qty units: 5 | # of repeats: 0 | DPMQ: $35.33 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Injection
Restriction
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 3 | # of repeats: 0 | DPMQ: $33.15 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Injection
Restriction
Indication: Endocarditis
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: 0 | DPMQ: $20.24 | Max safety net: $21.72 | General Patient Charge: $24.51 |
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Manner of administration:Injection
Restriction
Indication: Endophthalmitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 3 | # of repeats: 0 | DPMQ: $33.15 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction
Indication: Antibiotic associated pseudomembranous colitis
Restriction
Indication: Antibiotic associated pseudomembranous colitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 40 | # of repeats: 0 | DPMQ: $98.08 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction
Indication: Antibiotic associated pseudomembranous colitis
Restriction
Indication: Antibiotic associated pseudomembranous colitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 40 | # of repeats: 0 | DPMQ: $185.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Injection
Restriction
Indication: Endocarditis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $22.42 | Max safety net: $23.90 | General Patient Charge: $25.00 |
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Manner of administration:Injection
Restriction
Indication: Endophthalmitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 5 | Max qty units: 5 | # of repeats: 0 | DPMQ: $35.33 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Manner of administration:Injection
Restriction
Indication: Endocarditis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $22.42 | Max safety net: $23.90 | General Patient Charge: $25.00 |
| Available brands | |||||
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Manner of administration:Injection
Restriction
Indication: Endocarditis
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: 0 | DPMQ: $20.24 | Max safety net: $21.72 | General Patient Charge: $24.51 |
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