FOLINIC ACID

FOLINIC ACID (5890B)

folinic acid 50 mg/5 mL injection, 5 mL vial
5890B
Body System:
Manner of administration:Injection
Section 100 (CT)
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 10 Max qty units: 10 # of repeats: 2 DPMQ: $195.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Leucovorin Calcium

FOLINIC ACID (8740B)

folinic acid 50 mg/5 mL injection, 5 mL vial
8740B
Body System:
Manner of administration:Injection
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 10 Max qty units: 10 # of repeats: 2 DPMQ: $228.98 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Leucovorin Calcium