MOMETASONE

mometasone furoate 0.1% lotion, 30 mL

MOMETASONE (10804P)

mometasone furoate 0.1% lotion, 30 mL
10804P
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction  6231

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 5 Max qty units: 5 # of repeats: 5 DPMQ: $39.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Novasone
Zatamil
Elocon
*Additional charge for this brand is $27.50
 DPMQ: $67.43 Max safety net: $25.00 General Patient Charge: $52.50