MOMETASONE

mometasone furoate 0.1% ointment, 15 g

MOMETASONE (10828X)

mometasone furoate 0.1% ointment, 15 g
10828X
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction  6218

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: $36.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
GLENMARK MOMETASONE
Novasone
Zatamil
Elocon
*Additional charge for this brand is $21.18
 DPMQ: $57.54 Max safety net: $25.00 General Patient Charge: $46.18