DICLOXACILLIN

dicloxacillin 500 mg capsule, 24

DICLOXACILLIN (8122L)

dicloxacillin 500 mg capsule, 24
8122L
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: $21.89 Max safety net: $23.37 General Patient Charge: $25.00
Available brands
ARX-Dicloxacillin
DICLOXACILLIN VIATRIS 500
Distaph 500
*Additional charge for this brand is $1.95
 DPMQ: $23.84 Max safety net: $23.37 General Patient Charge: $26.95