VALSARTAN

VALSARTAN (13383J)

valsartan 320 mg tablet, 28
13383J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $31.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilart
Diovan

VALSARTAN (13414B)

valsartan 80 mg tablet, 28
13414B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $24.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilart
Diovan

VALSARTAN (13566B)

valsartan 160 mg tablet, 28
13566B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $27.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dilart
Diovan

VALSARTAN (9368C)

valsartan 40 mg tablet, 28
9368C
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 0 DPMQ: $19.16 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Dilart
Diovan

VALSARTAN (9369D)

valsartan 80 mg tablet, 28
9369D
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $19.58 Max safety net: $21.12 General Patient Charge: $23.91
Available brands
Dilart
Diovan

VALSARTAN (9370E)

valsartan 160 mg tablet, 28
9370E
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $21.02 Max safety net: $22.56 General Patient Charge: $25.00
Available brands
Dilart
Diovan

VALSARTAN (9371F)

valsartan 320 mg tablet, 28
9371F
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $22.90 Max safety net: $24.44 General Patient Charge: $25.00
Available brands
Dilart
Diovan