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: $35.59 | 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: $20.62 | Max safety net: $22.16 | General Patient Charge: $24.95 |
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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 |
| 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: $22.86 | Max safety net: $24.40 | General Patient Charge: $25.00 |
| Available brands | |||||
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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: $35.59 | 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: $22.86 | Max safety net: $24.40 | 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: $20.62 | Max safety net: $22.16 | General Patient Charge: $24.95 |
| Available brands | |||||
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