MESALAZINE
mesalazine 1 g/application foam, 14 applications
MESALAZINE (8768L)
8768L
Manner of administration:Rectal
Restriction (Streamlined authority code: 16632)
Indication: Mild to moderate ulcerative colitis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $248.16 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Salofalk | |||||