DABIGATRAN

DABIGATRAN (9318K)

dabigatran etexilate 75 mg capsule, 10
9318K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4369)

Indication: Prevention of venous thromboembolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 20 # of repeats: 1 DPMQ: $32.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PHARMACOR DABIGATRAN

DABIGATRAN (9322P)

dabigatran etexilate 75 mg capsule, 10
9322P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4381)

Indication: Prevention of venous thromboembolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 20 # of repeats: 0 DPMQ: $32.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PHARMACOR DABIGATRAN