Source	Section 100 (CT)
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
5960QMP	MESNA mesna 400 mg/4 mL injection, 15 x 4 mL ampoules (PI, CMI)	1	15	5	$51.74	$31.60	$31.60
	Available brands
	Uromitexan