AL OH/DIPHENHYDRAMINE/LIDOCAINE/MAG/SIMETHICONE MOUTHWASH (17537) VA PRODUCT (50.68)

Name	Value
NAME	AL OH/DIPHENHYDRAMINE/LIDOCAINE/MAG/SIMETHICONE MOUTHWASH
VA GENERIC NAME	AL OH/DIPHENHYDRAMINE/LIDOCAINE/MAGNESIUM/SIMETHICONE
DOSAGE FORM	SUSP,ORAL
ACTIVE INGREDIENTS	ALUMINUM HYDROXIDE STRENGTH: 3.15 UNITS: GM SIMETHICONE STRENGTH: 0.315 UNITS: GM DIPHENHYDRAMINE STRENGTH: 0.2 UNITS: GM MAGNESIUM HYDROXIDE STRENGTH: 3.15 UNITS: GM LIDOCAINE STRENGTH: 1.6 UNITS: GM
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	AL OH/DIPHENHYDRAMINE/LIDOCAINE/MAGNESIUM/SIMETHICONE SUSP,ORAL
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	ALOH/DIPH/MAG/LIDO/SIMET 1:1:1 MOUTHWASH
VA PRODUCT IDENTIFIER	A1297
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4025038
EFFECTIVE DATE/TIME	2006-03-28 00:00:00 STATUS: ACTIVE 2021-04-05 00:00:00 STATUS: ACTIVE 2021-07-14 00:00:00 STATUS: ACTIVE 2021-11-04 00:00:00 STATUS: ACTIVE