Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11126NMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 10 x 5 mL ampoules (PI, CMI)	1	10	0	$762.70	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11128QMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 10 x 5 mL ampoules (PI, CMI)	1	10	0	$801.88	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11194EMP	BACLOFEN baclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule (PI, CMI)	2	2	0	$644.51	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecal

Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11195FMP	BACLOFEN baclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule (PI, CMI)	2	2	0	$611.38	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecal