Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12184GMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 7.5 cm x 7.5 cm dressing, 10 (PI, CMI)
	Available brands
	Mepilex Border Flex 595211	1	1	0	$54.43	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12185HMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 15 cm x 20 cm dressing, 10 (PI, CMI)
	Available brands
	Mepilex Border Flex 595611	1	1	0	$179.39	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12195WMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 22 cm x 23 cm dressing, 6 (PI, CMI)
	Available brands
	Mepilex Border Heel 282750	1	1	0	$168.99	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12206KMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	Mepilex Border Flex 595311	1	1	0	$72.49	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12207LMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 22 cm x 25 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Border Sacrum 282450	1	1	0	$129.26	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

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
12216YMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 16 cm x 20 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Border Sacrum 282050	1	1	0	$85.55	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
4196WMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Gentle 66800248	1	1	0	$87.60	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
4207KMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 7.5 cm x 7.5 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Gentle Border 66800269	1	1	0	$67.84	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	VARIOUS > ALL OTHER NON-THERAPEUTIC PRODUCTS > ALL OTHER NON-THERAPEUTIC PRODUCTS

Note

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
4230PMP	DRESSING FOAM WITH SILICONE HEAVY EXUDATER dressing foam with silicone heavy exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	Allevyn Gentle Border 66800270	1	1	0	$95.01	$7.70	$7.70