CLOTRIMAZOLE

Body System:

Manner of administration:Application

Repatriation Pharmaceutical Benefits

No restrictions

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 1	# of repeats: 1	DPMQ: -	Max safety net: -	General Patient Charge: -
Available brands
Clonea			DPMQ: $16.15	Max safety net: $7.70	General Patient Charge: $7.70
Pharmacy Action Anti-Fungal Cream			DPMQ: $15.84	Max safety net: $7.70	General Patient Charge: $7.70

Body System:

Manner of administration:Application

Repatriation Pharmaceutical Benefits

No restrictions

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 1	# of repeats: 0	DPMQ: -	Max safety net: -	General Patient Charge: -
Available brands
APO-Clotrimazole 6 Day Cream			DPMQ: $21.32	Max safety net: $7.70	General Patient Charge: $7.70
Clonea 6 Day Cream			DPMQ: $20.11	Max safety net: $7.70	General Patient Charge: $7.70
Pharmacy Action FemCream			DPMQ: $20.11	Max safety net: $7.70	General Patient Charge: $7.70
Trust Fem V 6 Day Cream			DPMQ: $20.11	Max safety net: $7.70	General Patient Charge: $7.70

Body System:

Manner of administration:Application

Repatriation Pharmaceutical Benefits

No restrictions

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 1	# of repeats: 0	DPMQ: -	Max safety net: -	General Patient Charge: -
Available brands
APO-Clotrimazole 3 Day Cream			DPMQ: $21.32	Max safety net: $7.70	General Patient Charge: $7.70
Clonea 3 Day Cream			DPMQ: $21.32	Max safety net: $7.70	General Patient Charge: $7.70
Pharmacy Action FemCream 3 Day Cream			DPMQ: $21.32	Max safety net: $7.70	General Patient Charge: $7.70
Trust Fem V 3 Day Cream			DPMQ: $21.32	Max safety net: $7.70	General Patient Charge: $7.70

CLOTRIMAZOLE (4004R)