DICLOXACILLIN

dicloxacillin 250 mg capsule, 24

DICLOXACILLIN (8121K)

dicloxacillin 250 mg capsule, 24
8121K
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Serious staphylococcal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 24 # of repeats: 0 DPMQ: $18.90 Max safety net: $20.44 General Patient Charge: $23.23
Available brands
ARX-Dicloxacillin
DICLOXACILLIN VIATRIS 250
Distaph 250
*Additional charge for this brand is $1.83
 DPMQ: $20.73 Max safety net: $20.44 General Patient Charge: $25.06