COAL TAR 12.5%/MENTHOL 1.5% SHAMPOO (11753) VA PRODUCT (50.68)

Name	Value
NAME	COAL TAR 12.5%/MENTHOL 1.5% SHAMPOO
VA GENERIC NAME	COAL TAR/MENTHOL
DOSAGE FORM	SHAMPOO
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 1.5 UNITS: % ALCOHOL STRENGTH: 10.4 UNITS: % COAL TAR SOLUTION STRENGTH: 12.5 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
DSS NUMBER	1
NATIONAL FORMULARY NAME	COAL TAR/MENTHOL 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	4012122
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE