Source	S100 HSD Community Access
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
10277XMPNP	VALGANCICLOVIR valganciclovir 50 mg/mL powder for oral liquid, 100 mL (PI, CMI)	11	11	5	$4397.97	$31.60	$31.60
	Available brands
	Valcyte

Source	S100 HSD Community Access
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
10306KMPNP	VALGANCICLOVIR valganciclovir 450 mg tablet, 60 (PI, CMI)	2	120	5	$503.93	$31.60	$31.60
	Available brands
	Valganciclovir Sandoza
	Valganciclovir Viatrisa

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
6357NMP	VALGANCICLOVIR valganciclovir 450 mg tablet, 60 (PI, CMI)	2	120	5	$503.93	$31.60	$31.60
	Available brands
	Valganciclovir Sandoza
	Valganciclovir Viatrisa

Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
9569PMP	VALGANCICLOVIR valganciclovir 450 mg tablet, 60 (PI, CMI)	2	120	5	$476.22	$31.60	$31.60
	Available brands
	Valganciclovir Sandoza
	Valganciclovir Viatrisa

Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
9655EMP	VALGANCICLOVIR valganciclovir 50 mg/mL powder for oral liquid, 100 mL (PI, CMI)	11	11	5	$4346.10	$31.60	$31.60
	Available brands
	Valcyte

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
9675FMP	VALGANCICLOVIR valganciclovir 50 mg/mL powder for oral liquid, 100 mL (PI, CMI)	11	11	5	$4397.97	$31.60	$31.60
	Available brands
	Valcyte