ERYTHROMYCIN

ERYTHROMYCIN (10780J)

erythromycin 250 mg enteric capsule, 25
10780J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6160)

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 5 DPMQ: $37.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mayne Pharma Erythromycin

ERYTHROMYCIN (1404X)

erythromycin 250 mg enteric capsule, 25
1404X
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: 25 # of repeats: 1 DPMQ: $25.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mayne Pharma Erythromycin

ERYTHROMYCIN (14409J)

erythromycin 250 mg enteric capsule, 25
14409J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15710)

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 100 # of repeats: 2 DPMQ: $61.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mayne Pharma Erythromycin

ERYTHROMYCIN (3325B)

erythromycin 250 mg enteric capsule, 25
3325B
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: 25 # of repeats: 0 DPMQ: $25.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mayne Pharma Erythromycin