DICLOFENAC

DICLOFENAC (1299J)

diclofenac sodium 25 mg enteric tablet, 50
1299J
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: 2 Max qty units: 100 # of repeats: 3 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Clonac 25
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 25
*Additional charge for this brand is $9.96
 DPMQ: $29.18 Max safety net: $20.70 General Patient Charge: $33.45

DICLOFENAC (5076E)

diclofenac sodium 25 mg enteric tablet, 50
5076E
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: 2 Max qty units: 100 # of repeats: 0 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Clonac 25
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 25
*Additional charge for this brand is $9.96
 DPMQ: $29.18 Max safety net: $20.70 General Patient Charge: $33.45