| NAME |
SODIUM FLUORIDE 2.72% GEL,DENT |
| VA GENERIC NAME |
SODIUM FLUORIDE |
| DOSAGE FORM |
GEL |
| FORMULARY DESIGNATOR TEXT |
Not provided by pharmacy for inpatient use.
|
| ACTIVE INGREDIENTS |
|
| STRENGTH |
2.72 |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
SODIUM FLUORIDE GEL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SODIUM FLUORIDE 2.72%(FL 1.23%) DENT GEL |
| VA PRODUCT IDENTIFIER |
S0691 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4031622 |
| EFFECTIVE DATE/TIME |
-
- 2012-09-10 00:00:00
- STATUS: ACTIVE
|
