Voriconazole Eye Ointment

$53.00

Eye Ointment Strength

Eye Ointment Size

Clear

Clinic Name *Clinic name

Clinic Phone Number *Clinic phone number

Clinic State *State the clinic is located in

Person Placing *Full Name of Person(s) who can verify the order

Order Type *Select type of Order (Who is Paying)

Bill and Ship Clinic

Bill and Ship Owner

Bill Clinic and Ship Owner

Owner Name *Owner's full name

Owner Phone Number *Owner's phone number

Is this a refill?

Pet Name *Pet's full name

Pet Species *Species of pet

Sig *Sig (Directions)

Refills *Number of Refills (0-PRN)

Medical Rationale *

Doctor's Name *Prescribing doctor's name is it appears on their license

License NumberPrescribing doctor's license number

Question *Do you understand that we are a Compounding Pharmacy and that this drug is made from a bulk medication that isn't commercially available in this form, strength, or flavor?

Yes

SKU: N/A Category: Ophthalmic (Eye)

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Additional information

Eye Ointment Strength	1%, 2%
Eye Ointment Size	5GM

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Voriconazole Eye Ointment

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