GLYCERIN 0.2%/HYPROMELLOSE 0.2%/POLYETHYLENE GLYCOL 1%/ SOLN,OPH (17593) VA PRODUCT (50.68)

Name	Value
NAME	GLYCERIN 0.2%/HYPROMELLOSE 0.2%/POLYETHYLENE GLYCOL 1%/ SOLN,OPH
VA GENERIC NAME	GLYCERIN/HYPROMELLOSE/POLYETHYLENE GLYCOL
DOSAGE FORM	SOLN,OPH
ACTIVE INGREDIENTS	GLYCERIN STRENGTH: 0.2 UNITS: % HYPROMELLOSE STRENGTH: 0.2 UNITS: % POLYETHYLENE GLYCOL STRENGTH: 1 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
NATIONAL FORMULARY NAME	GLYCERIN/HYPROMELLOSE/POLYETHYLENE GLYCOL SOLN,OPH
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	GLYCERIN/H-MELLOSE/POLY GLYCOL OPH SOLN
VA PRODUCT IDENTIFIER	G0268
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4025125
EFFECTIVE DATE/TIME	2006-05-22 00:00:00 STATUS: ACTIVE 2012-06-06 00:00:00 STATUS: INACTIVE 2017-12-05 00:00:00 STATUS: ACTIVE