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
12774HMP	DRESSING FOAM WITH SILICONE LIGHT EXUDATER dressing foam with silicone light exudate 5 cm x 12.5 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Border Lite 281100	1	1	0	$33.46	$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
12780PMP	DRESSING FOAM WITH SILICONE LIGHT EXUDATER dressing foam with silicone light exudate 4 cm x 5 cm dressing, 10 (PI, CMI)
	Available brands
	Mepilex Border Lite 281000	1	1	0	$30.88	$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
12804XMP	DRESSING FOAM WITH SILICONE LIGHT EXUDATER dressing foam with silicone light exudate 10 cm x 10 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Border Lite 281300	1	1	0	$40.45	$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
4644KMP	DRESSING FOAM WITH SILICONE LIGHT EXUDATER dressing foam with silicone light exudate 6 cm x 8.5 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Lite 284000	1	1	0	$32.28	$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
4645LMP	DRESSING FOAM WITH SILICONE LIGHT EXUDATER dressing foam with silicone light exudate 10 cm x 10 cm dressing, 5 (PI, CMI)
	Available brands
	Mepilex Lite 284100	1	1	0	$41.10	$7.70	$7.70