| NAME |
HYDROCREAM BASE |
| VA GENERIC NAME |
IMIDAZOLIDINYL UREA/PARABEN/MINERAL OIL/PETROLATUM |
| DOSAGE FORM |
CREAM |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
IMIDAZOLIDINYL UREA/PARABEN/MINERAL OIL/PETROLATUM CREAM |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 0
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| TRANSMIT TO CMOP |
NO |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4010453 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
