DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE SUSP,ORAL (22632)    VA PRODUCT (50.68)

Name Value
NAME DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE SUSP,ORAL
VA GENERIC NAME DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE
DOSAGE FORM SUSP,ORAL
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Single source
INACTIVATION DATE 2013-06-21 00:00:00
NATIONAL FORMULARY NAME DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE 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 FIRST MARYS MOUTHWASH
VA PRODUCT IDENTIFIER D0901
TRANSMIT TO CMOP YES
VA DISPENSE UNIT ML
MASTER ENTRY FOR VUID YES
VUID 4030950
EFFECTIVE DATE/TIME
  • 2011-09-12 00:00:00
    STATUS:   ACTIVE