ALOE VESTA 3-N-1 CLEANSING FOAM,TOP (15080)    VA PRODUCT (50.68)

Name Value
NAME ALOE VESTA 3-N-1 CLEANSING FOAM,TOP
VA GENERIC NAME CLEANSER
DOSAGE FORM FOAM,TOP
FORMULARY DESIGNATOR R
NATIONAL FORMULARY INDICATOR NO
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2010-05-17 00:00:00
NATIONAL FORMULARY NAME CLEANSER FOAM,TOP
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2017-06-30 00:00:00
  • COPAY TIER LEVEL:   0
    COPAY EFFECTIVE DATE:   2017-07-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME ALOE VESTA 3-N-1 CLEANSING TOP FOAM
VA PRODUCT IDENTIFIER A1087
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4015444
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2009-08-19 00:00:00
    STATUS:   INACTIVE
  • 2010-05-12 00:00:00
    STATUS:   ACTIVE
  • 2010-05-17 00:00:00
    STATUS:   INACTIVE