Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

Note

Restricted Benefit

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
12179BMP	BICARBONATE + CITRIC ACID + TARTARIC ACIDR sodium bicarbonate 1.76 g + citric acid 720 mg + sodium citrate 630 mg + tartaric acid 890 mg effervescent granules, 28 x 4 g sachets (PI, CMI)
	Available brands
	Trust Cystitis Reliefa	1	1	4	$19.66	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

Note

Restricted Benefit

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
4049DMP	BICARBONATE + CITRIC ACID + TARTARIC ACIDR sodium bicarbonate 1.76 g + sodium citrate 630 mg + citric acid 720 mg + tartaric acid 890 mg powder for oral liquid, 28 x 4 g sachets (PI, CMI)
	Available brands
	Pharmacy Action Cystitis Reliefa	1	1	4	$19.66	$7.70	$7.70
	Ural Sachetsa	1	1	4	$19.66	$7.70	$7.70