INTERFERON GAMMA-1B

INTERFERON GAMMA-1B (5769P)

interferon gamma-1b 2 million units (100 microgram)/0.5 mL injection, 6 x 0.5 mL vials
5769P
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6222)

Indication: Chronic granulomatous disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 12 # of repeats: 11 DPMQ: $1,719.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Imukin

INTERFERON GAMMA-1B (6148N)

interferon gamma-1b 2 million units (100 microgram)/0.5 mL injection, 6 x 0.5 mL vials
6148N
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9639)

Indication: Chronic granulomatous disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 12 # of repeats: 11 DPMQ: $1,768.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Imukin