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
4599CMP	DRESSING HYDROGEL AMORPHOUSR dressing hydrogel amorphous gel, 50 g (PI, CMI)
	Available brands
	SoloSite Gel 36361338	3	3	3	$42.45	$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
4894NMP	DRESSING HYDROGEL AMORPHOUSR dressing hydrogel amorphous gel, 25 g (PI, CMI)
	Available brands
	Intrasite Gel 7313	4	4	3	$86.63	$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
4912MMP	DRESSING HYDROGEL AMORPHOUSR dressing hydrogel amorphous gel, 10 x 15 g (PI, CMI)
	Available brands
	Comfeel Purilon Gel 3900	1	1	1	$73.16	$7.70	$7.70
	DuoDERM Gel 187990	1	1	1	$66.24	$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
4913NMP	DRESSING HYDROGEL AMORPHOUSR dressing hydrogel amorphous gel, 3 x 30 g (PI, CMI)
	Available brands
	DuoDERM Gel H7987	3	3	1	$95.91	$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
4914PMP	DRESSING HYDROGEL AMORPHOUSR dressing hydrogel amorphous gel, 50 g (PI, CMI)
	Available brands
	Solugel 10336	3	3	3	$36.69	$7.70	$7.70