MOMETASONE

mometasone furoate 0.1% ointment, 15 g

MOMETASONE (10793C)

mometasone furoate 0.1% ointment, 15 g
10793C
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6263)

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 8 # of repeats: 5 DPMQ: $43.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
GLENMARK MOMETASONE
Novasone
Zatamil
Elocon
*Additional charge for this brand is $28.24
 DPMQ: $72.08 Max safety net: $25.00 General Patient Charge: $53.24