RASH RELIEF ANTIBACTERIAL SPRAY,TOP (20765) VA PRODUCT (50.68)

Name	Value
NAME	RASH RELIEF ANTIBACTERIAL SPRAY,TOP
VA GENERIC NAME	BACITRACIN
DOSAGE FORM	SPRAY,TOP
ACTIVE INGREDIENTS	DIMETHICONE STRENGTH: 20 UNITS: % ZINC OXIDE STRENGTH: 25 UNITS: % BACITRACIN STRENGTH: 500 UNITS: UNIT/GM
NATIONAL FORMULARY NAME	BACITRACIN SPRAY,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
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	RASH RELIEF ANTIBACTERIAL TOP SPRAY
VA PRODUCT IDENTIFIER	R0261
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4028831
EFFECTIVE DATE/TIME	2009-08-11 00:00:00 STATUS: ACTIVE