AMOXICILLIN + CLAVULANIC ACID
Manner of administration:Oral
Restriction (Streamlined authority code: 10413)
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 20 | # of repeats: 0 | DPMQ: $21.00 | Max safety net: $22.54 | General Patient Charge: $25.00 |
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DPMQ: $33.92 | Max safety net: $22.54 | General Patient Charge: $37.92 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 10405)
Indication: Infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 20 | # of repeats: 0 | DPMQ: $20.44 | Max safety net: $21.98 | General Patient Charge: $24.77 |
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DPMQ: $30.70 | Max safety net: $21.98 | General Patient Charge: $35.03 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.40 | Max safety net: $18.94 | General Patient Charge: $21.73 |
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DPMQ: $22.53 | Max safety net: $18.94 | General Patient Charge: $26.86 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.68 | Max safety net: $19.22 | General Patient Charge: $22.01 |
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DPMQ: $24.14 | Max safety net: $19.22 | General Patient Charge: $28.47 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.40 | Max safety net: $18.94 | General Patient Charge: $21.73 |
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DPMQ: $22.53 | Max safety net: $18.94 | General Patient Charge: $26.86 | ||
Manner of administration:Oral
Restriction
Indication: Infection where resistance to amoxicillin is suspected
Restriction
Indication: Infections where resistance to amoxicillin is proven
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 10 | # of repeats: 0 | DPMQ: $17.68 | Max safety net: $19.22 | General Patient Charge: $22.01 |
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DPMQ: $24.14 | Max safety net: $19.22 | General Patient Charge: $28.47 | ||