SODIUM FLUORIDE 5% VARNISH,DENTAL (20521)    VA PRODUCT (50.68)

Name Value
NAME SODIUM FLUORIDE 5% VARNISH,DENTAL
VA GENERIC NAME SODIUM FLUORIDE
DOSAGE FORM VARNISH,DENTAL
FORMULARY DESIGNATOR TEXT
ACTIVE INGREDIENTS
NATIONAL FORMULARY INDICATOR YES
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 5
UNITS %
NATIONAL FORMULARY NAME SODIUM FLUORIDE VARNISH,DENTAL
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 SODIUM FLUORIDE 5% DENTAL VARNISH
VA PRODUCT IDENTIFIER S0617
TRANSMIT TO CMOP NO
VA DISPENSE UNIT PKT
MASTER ENTRY FOR VUID YES
VUID 4028529
EFFECTIVE DATE/TIME
  • 2009-04-08 00:00:00
    STATUS:   ACTIVE
  • 2012-06-25 00:00:00
    STATUS:   INACTIVE
  • 2012-10-05 00:00:00
    STATUS:   ACTIVE