DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
11911XMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 4 | $11622.16 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
11915DMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 4 | $11418.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13745KMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11622.16 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13766MMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11622.16 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13767NMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11418.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13775BMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 3 | $11418.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13779FMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 3 | $11622.16 | $31.60 | $31.60 |
DURVALUMAB
|
|
Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
---|---|---|---|---|---|---|---|---|---|
13780GMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11418.88 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner