Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
10017FMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 10.3 cm x 10.3 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life 66801067	1	1	0	$74.61	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
10021KMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 21 cm x 21 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life 66801070	1	1	0	$293.58	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
10023MMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 15.4 cm x 15.4 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life 66801069	1	1	0	$145.77	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
10029WMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 12.9 cm x 12.9 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life 66801068	1	1	0	$105.22	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
11384EMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 10.5 cm x 10.5 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life Non-Bordered 66801748	1	1	0	$69.51	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
11393PMP	DRESSING FOAM WITH SILICONER dressing foam with silicone 16 cm x 16 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Life Non-Bordered 66801749	1	1	0	$118.38	$7.70	$7.70