GANCICLOVIR
ganciclovir 500 mg injection, 5 vials
GANCICLOVIR (6136Y)
6136Y
Manner of administration:Injection
Restriction (Streamlined authority code: 15784)
Indication: Cytomegalovirus infection and disease
Restriction (Streamlined authority code: 15782)
Indication: Cytomegalovirus infection and disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 10 | # of repeats: 1 | DPMQ: $250.34 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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