MOMETASONE

mometasone furoate 0.1% lotion, 30 mL

MOMETASONE (10819K)

mometasone furoate 0.1% lotion, 30 mL
10819K
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6232)

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $24.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Novasone
Zatamil
Elocon
*Additional charge for this brand is $11.00
 DPMQ: $35.26 Max safety net: $25.00 General Patient Charge: $36.00