POTASSIUM NITRATE 5%/SODIUM FLUORIDE 1.1% GEL,DENT (21805)    VA PRODUCT (50.68)

Name Value
NAME POTASSIUM NITRATE 5%/SODIUM FLUORIDE 1.1% GEL,DENT
VA GENERIC NAME POTASSIUM NITRATE/SODIUM FLUORIDE
DOSAGE FORM GEL,DENT
FORMULARY DESIGNATOR TEXT 
Not provided by pharmacy for inpatient use.
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
NATIONAL FORMULARY NAME POTASSIUM NITRATE/SODIUM FLUORIDE GEL,DENT
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2020-06-17 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2020-06-18 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME POTASSIUM NIT 5%/SODIUM FL 1.1% DENT GEL
VA PRODUCT IDENTIFIER P0957
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4029997
EFFECTIVE DATE/TIME
  • 2010-08-13 00:00:00
    STATUS:   ACTIVE