DRESSING HYDROGEL AMORPHOUS

DRESSING HYDROGEL AMORPHOUS (4599C)

dressing hydrogel amorphous gel, 50 g
4599C
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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: 3 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
SoloSite Gel 36361338 DPMQ: $43.80 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROGEL AMORPHOUS (4894N)

dressing hydrogel amorphous gel, 25 g
4894N
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 3 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Intrasite Gel 7313 DPMQ: $90.68 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROGEL AMORPHOUS (4912M)

dressing hydrogel amorphous gel, 10 x 15 g
4912M
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
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: 1 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Comfeel Purilon Gel 3900 DPMQ: $73.49 Max safety net: $7.70 General Patient Charge: $7.70
DuoDERM Gel 187990 DPMQ: $66.57 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROGEL AMORPHOUS (4913N)

dressing hydrogel amorphous gel, 3 x 30 g
4913N
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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: 1 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
DuoDERM Gel H7987 DPMQ: $96.24 Max safety net: $7.70 General Patient Charge: $7.70

DRESSING HYDROGEL AMORPHOUS (4914P)

dressing hydrogel amorphous gel, 50 g
4914P
Body System:
Manner of administration:For External Use
Repatriation Pharmaceutical Benefits
No restrictions
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: 3 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Solugel 10336 DPMQ: $37.02 Max safety net: $7.70 General Patient Charge: $7.70