DIPHENHYDRAMINE/LIDOCAINE/NYSTATIN MOUTHWASH (21635) VA PRODUCT (50.68)

Name	Value
NAME	DIPHENHYDRAMINE/LIDOCAINE/NYSTATIN MOUTHWASH
VA GENERIC NAME	DIPHENHYDRAMINE/LIDOCAINE/NYSTATIN
DOSAGE FORM	SUSP,ORAL
ACTIVE INGREDIENTS	NYSTATIN STRENGTH: 1.6 UNITS: GM DIPHENHYDRAMINE HYDROCHLORIDE STRENGTH: 0.2 UNITS: GM LIDOCAINE HYDROCHLORIDE STRENGTH: 1.6 UNITS: GM
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
INACTIVATION DATE	2016-06-15 00:00:00
NATIONAL FORMULARY NAME	DIPHENHYDRAMINE/LIDOCAINE/NYSTATIN SUSP,ORAL
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	DIPHEN/LIDOCAINE/NYSTATIN MOUTHWASH
VA PRODUCT IDENTIFIER	D0844
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4029804
EFFECTIVE DATE/TIME	2010-05-12 00:00:00 STATUS: ACTIVE