HYDROCORTISONE ACETATE 2.5%/LIDOCAINE HCL 3% RTL,KIT (21344)    VA PRODUCT (50.68)

Name Value
NAME HYDROCORTISONE ACETATE 2.5%/LIDOCAINE HCL 3% RTL,KIT
VA GENERIC NAME HYDROCORTISONE/LIDOCAINE
DOSAGE FORM KIT
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME HYDROCORTISONE/LIDOCAINE KIT
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 HYDROCORTISONE 2.5%/LIDOCAINE 3% RTL,KIT
VA PRODUCT IDENTIFIER H0570
TRANSMIT TO CMOP NO
VA DISPENSE UNIT KIT
MASTER ENTRY FOR VUID YES
VUID 4029487
EFFECTIVE DATE/TIME
  • 2010-01-12 00:00:00
    STATUS:   ACTIVE