CONTACT LENS WET & SOAK SOLN (10106) VA PRODUCT (50.68)

Name	Value
NAME	CONTACT LENS WET & SOAK SOLN
VA GENERIC NAME	BENZALKONIUM CHLORIDE/EDETATE/POLYVINYL ALCOHOL
DOSAGE FORM	SOLN,CONTACT LENS
FORMULARY DESIGNATOR TEXT	Restricted to veterans who receive their contact lens from the VA
ACTIVE INGREDIENTS	POLYVINYL ALCOHOL EDETATE DISODIUM BENZALKONIUM CHLORIDE STRENGTH: 0.003 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2008-09-30 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	BENZALKONIUM CHLORIDE/EDETATE/POLYVINYL ALCOHOL SOLN
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 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	4010489
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2008-09-30 00:00:00 STATUS: INACTIVE