| Package AWP: | $16,610.00 |
| Package: | 20 ML |
| J-Code: | J1568 |
| Strength: | 50 MG/1 ML |
| Form: | Solution |
| NDC Number: | 68982084001 |
| Generic Name: | Immune Globulin |
| Brand Name: | OCTAGAM |
| Mfg. Part No: | OF84001 |
| Std Packaging: | 1 EACH |
| Manufacturer: | OCTAPHARMA |
| Replacement: | |
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