DRESSING FOAM WITH SILVER

DRESSING FOAM WITH SILVER (4252T)

dressing foam with silver 7.5 cm x 7.5 cm dressing, 10
4252T
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Adhesive 66800073 DPMQ: $183.03 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4255Y)

dressing foam with silver 10 cm x 10 cm dressing, 10
4255Y
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Adhesive 66800075 DPMQ: $272.09 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4258D)

dressing foam with silver 12.5 cm x 12.5 cm dressing, 10
4258D
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Adhesive 66800078 DPMQ: $337.92 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4259E)

dressing foam with silver 10 cm x 10 cm dressing, 10
4259E
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Non-Adhesive 66800086 DPMQ: $277.31 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4263J)

dressing foam with silver 7.5 cm x 7.5 cm dressing, 10
4263J
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Gentle Border 66800460 DPMQ: $183.03 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4266M)

dressing foam with silver 10 cm x 10 cm dressing, 10
4266M
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Gentle Border 66800461 DPMQ: $272.09 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING FOAM WITH SILVER (4270R)

dressing foam with silver 12.5 cm x 12.5 cm dressing, 10
4270R
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Wounds
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: - Max safety net: - General Patient Charge: -
Available brands
Allevyn Ag Gentle Border 66800462 DPMQ: $337.92 Max safety net: $7.70 General Patient Charge: $7.70