AZITHROMYCIN

AZITHROMYCIN (8201P)

azithromycin 200 mg/5 mL powder for oral liquid, 15 mL
8201P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Trachoma
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $29.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zithromax

AZITHROMYCIN (8336R)

azithromycin 500 mg tablet, 2
8336R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Trachoma
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $18.18 Max safety net: $19.66 General Patient Charge: $22.45
Available brands
APO-Azithromycin
AZITHROMYCIN-WGR
Azithromycin Sandoz
Azithromycin Viatris
ZITHRO
Zithromax