AMOXICILLIN + CLAVULANIC ACID
Manner of administration:Oral
Restriction (Streamlined authority code: 10413)
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 20 | # of repeats: 0 | DPMQ: $20.42 | Max safety net: $21.90 | General Patient Charge: $24.69 |
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DPMQ: $33.98 | Max safety net: $21.90 | General Patient Charge: $38.25 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 10405)
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 20 | # of repeats: 0 | DPMQ: $19.82 | Max safety net: $21.30 | General Patient Charge: $24.09 |
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DPMQ: $30.64 | Max safety net: $21.30 | General Patient Charge: $34.91 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $16.80 | Max safety net: $18.28 | General Patient Charge: $21.07 |
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DPMQ: $22.21 | Max safety net: $18.28 | General Patient Charge: $26.48 | ||
amoxicillin 125 mg/5 mL + clavulanic acid 31.25 mg/5 mL powder for oral liquid, 75
mL
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
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: $19.86 | Max safety net: $21.77 | General Patient Charge: $24.56 |
| Available brands | |||||
| Curam | |||||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.10 | Max safety net: $18.58 | General Patient Charge: $21.37 |
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DPMQ: $23.88 | Max safety net: $18.58 | General Patient Charge: $28.15 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $16.80 | Max safety net: $18.28 | General Patient Charge: $21.07 |
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DPMQ: $22.21 | Max safety net: $18.28 | General Patient Charge: $26.48 | ||
amoxicillin 125 mg/5 mL + clavulanic acid 31.25 mg/5 mL powder for oral liquid, 75
mL
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
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: $19.86 | Max safety net: $21.77 | General Patient Charge: $24.56 |
| Available brands | |||||
| Curam | |||||
amoxicillin 400 mg/5 mL + clavulanic acid 57 mg/5 mL powder for oral liquid, 60 mL
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
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: $19.86 | Max safety net: $21.77 | General Patient Charge: $24.56 |
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DPMQ: $25.12 | Max safety net: $21.77 | General Patient Charge: $29.82 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.10 | Max safety net: $18.58 | General Patient Charge: $21.37 |
| Available brands | |||||
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DPMQ: $23.88 | Max safety net: $18.58 | General Patient Charge: $28.15 | ||
amoxicillin 400 mg/5 mL + clavulanic acid 57 mg/5 mL powder for oral liquid, 60 mL
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
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: $19.86 | Max safety net: $21.77 | General Patient Charge: $24.56 |
| Available brands | |||||
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DPMQ: $25.12 | Max safety net: $21.77 | General Patient Charge: $29.82 | ||