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
13003JMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE MODERATE EXUDATER dressing foam lipidocolloid with sucrose octasulfate moderate exudate 15 cm x 20 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Pad 100377	1	1	3	$301.99	$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
13004KMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE MODERATE EXUDATER dressing foam lipidocolloid with sucrose octasulfate moderate exudate 12 cm x 19 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Pad 100378	1	1	3	$226.19	$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
13008PMP	DRESSING FOAM LIPIDOCOLLOID WITH SUCROSE OCTASULFATE MODERATE EXUDATER dressing foam lipidocolloid with sucrose octasulfate moderate exudate 10 cm x 10 cm dressing, 10 (PI, CMI)
	Available brands
	UrgoStart Pad 100376	1	1	3	$139.08	$7.70	$7.70