Package Smallest Daily drug Package format unit price $ cost per Dosage Route of format + DIN Strength $ (to 4 (to 4 patient $ (to form administration per decimal decimal 4 decimal package places) places) places) Enter more rows in the table as necessary.
DIN Strength Dosage form Route of administration Package format + per package Package format $ (to 4 decimal places) Smallest unit price $ (to 4 decimal places) Daily drug cost per patient $ (to 4 decimal places) Enter more rows in the table as necessary.
drug-product-request-form-non-cdr-drugs.docx