LEVODOPA + CARBIDOPA + ENTACAPONE
levodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100
Body System:
Manner of administration:Oral
Restriction
Indication: Parkinson disease
Restriction
Indication: Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 400 | # of repeats: 4 | DPMQ: $197.52 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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levodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100
Body System:
Manner of administration:Oral
Restriction
Indication: Parkinson disease
Restriction
Indication: Parkinson 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: 200 | # of repeats: 4 | DPMQ: $103.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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