RIFABUTIN

RIFABUTIN (6195C)

rifabutin 150 mg capsule, 30
6195C
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9560)

Indication: Mycobacterium avium complex infection

Restriction (Streamlined authority code: 9622)

Indication: Mycobacterium avium complex infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 120 # of repeats: 5 DPMQ: $555.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mycobutin

RIFABUTIN (9541E)

rifabutin 150 mg capsule, 30
9541E
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6350)

Indication: Mycobacterium avium complex infection

Restriction (Streamlined authority code: 6356)

Indication: Mycobacterium avium complex infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 120 # of repeats: 5 DPMQ: $525.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mycobutin