PEDI-DRI PWDR,TOP (10147) VA PRODUCT (50.68)

Name	Value
NAME	PEDI-DRI PWDR,TOP
VA GENERIC NAME	ALUMINUM CHLOROHYDREX/FORMALDEHYDE/MENTHOL/ZINC UNDECYLENATE
DOSAGE FORM	KIT
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 1 UNITS: % FORMALDEHYDE STRENGTH: 0.5 UNITS: % ZINC UNDECYLENATE STRENGTH: 0.5 UNITS: % ALUMINUM CHLOROHYDREX STRENGTH: 2.5 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
INACTIVATION DATE	2016-06-21 00:00:00
DSS NUMBER	4
NATIONAL FORMULARY NAME	ALUMINUM CHLOROHYDREX/FORMALDEHYDE/MENTHOL/ZINC UNDECYLENATE KIT
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
VA PRINT NAME	PEDI-DRI TOP PWDR
VA PRODUCT IDENTIFIER	P0828
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	NO
VUID	4010527
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2004-11-19 00:00:00 STATUS: INACTIVE