THALIDOMIDE

THALIDOMIDE (9667T)

thalidomide 100 mg capsule, 28
9667T
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: 2 Max qty units: 56 # of repeats: 0 DPMQ: $1,061.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Thalomid

THALIDOMIDE (9684Q)

thalidomide 100 mg capsule, 28
9684Q
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: 2 Max qty units: 56 # of repeats: 0 DPMQ: $1,110.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Thalomid