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Enteral PPD & Part-B
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Alginates

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ConvaTec Aquacel Ag Advantage Dressing, 2"x2"
422297
Off-Formulary 0.0 USD
ConvaTec Aquacel Ag Advantage Dressing, 4"x5"
422299
Off-Formulary 0.0 USD
Dermarite DermaGinate Ag Alginate Wound Dressing with Antibacterial Silver 2”x2"
00520E
Off-Formulary 0.0 USD
Dermarite DermaGinate Ag Alginate Wound Dressing with Antibacterial Silver 4”x5"
00525E
Off-Formulary 0.0 USD
Dermarite DermaGinate Ag Silver Alginate Rope, 12"
00530E
Off-Formulary 0.0 USD
Dermarite DermaGinate Alginate Rope, 12"
00275E
Off-Formulary 0.0 USD
Dermarite DermaGinate Alginate Wound Dressing 2”x2"
00260E
Off-Formulary 0.0 USD
Dermarite DermaGinate Alginate Wound Dressing 4.25”x4.25"
00270E
Off-Formulary 0.0 USD
Dermarite DermaGinate Alginate Wound Dressing 4”x8"
00272E
Off-Formulary 0.0 USD
Dermarite SilverDerm7 Silver Wound Contact Layer Dressing 4”x4"
00550E
Off-Formulary 0.0 USD
Gentell Alginate Wound Dressing 10"x10"
GEN-13010
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 3"x3"
413900
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 4"x4"
413901
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 5"x5"
413902
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 6"x6"
413903
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 7"x7"
413924
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Dressing, 8"x8"
413905
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Silicone Bordered Super Absorbent Sacral Dressing, 7"x7"
413906
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Super Absorbent Dressing, 4"x4"
413110
Off-Formulary 0.0 USD
Hartmann Zetuvit Plus Super Absorbent Dressing, 4"x8"
413111
Off-Formulary 0.0 USD