Product
Acyclonine MUM
(acyclovir / triamcinolone acetonide / dyclonine HCl)
(36.7% / 16.7% / 3.33%)
Package Size (3 gm)

I am a representative of this office and am responsible for the submission of this order, I authorize Nubratori Rx to ship all items listed above. The practitioner agrees that any changes between the compounded drug and a comparable approved drug will be administered or dispensed only to a patient for whom the change will help to make a clinical difference, as determined by the practitioner or a person able to make that representation on the practitioner’s behalf. The practitioner further agrees to maintain documentation sufficient to demonstrate that the compounded preparation is only provided to such patients.

By working with Nubratori RX you agree that in no event shall Nubratori RX, its employees, agents, its licensors, its suppliers, its software, or any of its third parties mentioned shall be liable for any damages including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or any damages or liability resulting from advice from its employees, outside contractors, from its third parties, or its software. Nubratori RX is not liable for any personal injury, including death, caused by your use or misuse of the content, advice, information or communication issued to you in any form (electronic, oral, written, or facsimile). The licensed physician/provider/ third party biller, is solely responsible for determining pricing and billing to all insurers, third parties, and / or patients and abides by all federal, state and local laws. You agree that in no event shall Nubratori RX its employees , agents, consultants, its outside contractors, its licensors, its suppliers, its software, or any of its third parties mentioned shall be liable for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death)resulting from the sale, dispensing, resale or use of any products, advice, or services by Nubratori RX, its employees, outside contractors, licensors, its suppliers, or its third parties.