Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
10057HMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	1	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
10067WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	1	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
10184BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
10196PMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11389KMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11396TMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11399YMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11400BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11412PMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11423FMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11424GMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11432QMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11445JMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11448MMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11449NMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11450PMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11459DMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11461FMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11482HMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11483JMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	3	3	2	$589.50	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11486MMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	3	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11488PMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	3	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11489QMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11490RMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	3	3	2	$558.48	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11497DMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11498EMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11514BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11515CMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11590BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11595GMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11605TMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11606WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
11796WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.72	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
11797XMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
13700CMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	3	3	2	$589.50	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
13723GMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
13724HMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

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
13734WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	3	3	2	$558.48	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
13765LMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
13778EMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

Source	Repatriation Pharmaceutical Benefits
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
4284LMP	INFLIXIMABR infliximab 100 mg injection, 1 vial (PI, CMI)
	Available brands
	Remicade	1	1	2	$215.30	$7.70	$7.70

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5753TMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5754WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5755XMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5756YMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5757BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
5758CMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
6397QMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
6448JMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
6496XMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
9612XMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
9613YMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
9617EMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
9654DMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

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
9674EMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.28	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa