COAL TAR 2%/SALICYLIC ACID SHAMPOO (21019)    VA PRODUCT (50.68)

Name Value
NAME COAL TAR 2%/SALICYLIC ACID SHAMPOO
VA GENERIC NAME COAL TAR/SALICYLIC ACID
DOSAGE FORM SHAMPOO
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2019-12-16 00:00:00
NATIONAL FORMULARY NAME COAL TAR/SALICYLIC ACID SHAMPOO
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 COAL TAR 2%/SALICYLIC ACID SHAMPOO
VA PRODUCT IDENTIFIER C1403
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4029121
EFFECTIVE DATE/TIME
  • 2009-10-01 00:00:00
    STATUS:   ACTIVE
  • 2019-12-16 00:00:00
    STATUS:   INACTIVE