| Package AWP: | $166,104.00 |
| Package: | 100 ML |
| J-Code: | J1568 |
| Strength: | 100 MG/1 ML |
| Form: | Solution |
| NDC Number: | 68982085003 |
| Generic Name: | Immune Globulin |
| Brand Name: | OCTAGAM 10% |
| Mfg. Part No: | OF85003 |
| Std Packaging: | 1 EACH |
| Manufacturer: | OCTAPHARMA |
| Replacement: | |
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