MICONAZOLE

MICONAZOLE (9027D)

miconazole nitrate 2% cream, 30 g
9027D
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6434)

Indication: Fungal or yeast infection
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: 2 DPMQ: $19.36 Max safety net: $20.84 General Patient Charge: $23.63
Available brands
Daktarin

MICONAZOLE (9028E)

miconazole nitrate 2% cream, 70 g
9028E
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6434)

Indication: Fungal or yeast infection
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: $20.57 Max safety net: $22.05 General Patient Charge: $24.84
Available brands
Daktarin

MICONAZOLE (9029F)

miconazole nitrate 2% powder, 30 g
9029F
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6434)

Indication: Fungal or yeast infection
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: 2 DPMQ: $19.86 Max safety net: $21.34 General Patient Charge: $24.13
Available brands
Daktarin

MICONAZOLE (9031H)

miconazole 2% solution, 30 mL
9031H
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6434)

Indication: Fungal or yeast infection
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: 2 DPMQ: $22.26 Max safety net: $23.74 General Patient Charge: $25.00
Available brands
Daktarin Tincture