MOMETASONE

MOMETASONE (10812C)

mometasone furoate 0.1% ointment, 15 g
10812C
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: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
GLENMARK MOMETASONE
Novasone
Zatamil
Elocon
*Additional charge for this brand is $7.06
 DPMQ: $28.38 Max safety net: $22.80 General Patient Charge: $32.06