THALIDOMIDE

THALIDOMIDE (6469L)

thalidomide 50 mg capsule, 28
6469L
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9290)

Indication: Multiple myeloma
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 112 # of repeats: 0 DPMQ: $1,110.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Thalomid

THALIDOMIDE (9566L)

thalidomide 50 mg capsule, 28
9566L
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5914)

Indication: Multiple myeloma
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 112 # of repeats: 0 DPMQ: $1,061.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Thalomid