PHACID CLEANSING SHAMPOO (10126) VA PRODUCT (50.68)

Name	Value
NAME	PHACID CLEANSING SHAMPOO
VA GENERIC NAME	EDTA/PHOSPHORIC ACID/PROPYLENE GLYCOL/SODIUM LAURYL SULFATE
DOSAGE FORM	SHAMPOO
ACTIVE INGREDIENTS	PROPYLENE GLYCOL PHOSPHORIC ACID WATER SODIUM LAURYL SULFATE EDTA
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-10-01 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	EDTA/PHOSPHORIC ACID/PROPYLENE GLYCOL/SODIUM LAURYL SULFATE SHAMPOO
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	4010506
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-10-01 00:00:00 STATUS: INACTIVE