RASH RELIEF ANTIFUNGAL SPRAY,TOP (20767) VA PRODUCT (50.68)

Name	Value
NAME	RASH RELIEF ANTIFUNGAL SPRAY,TOP
VA GENERIC NAME	MICONAZOLE
DOSAGE FORM	SPRAY,TOP
ACTIVE INGREDIENTS	MICONAZOLE STRENGTH: 2 UNITS: % PETROLATUM STRENGTH: 10 UNITS: % DIMETHICONE STRENGTH: 10 UNITS: % ZINC OXIDE STRENGTH: 10 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
NATIONAL FORMULARY NAME	MICONAZOLE 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 ANTIFUNGAL TOP SPRAY
VA PRODUCT IDENTIFIER	R0262
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4028833
EFFECTIVE DATE/TIME	2009-08-11 00:00:00 STATUS: ACTIVE