| NAME |
DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE MOUTHWASH |
| 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 |
2016-06-15 00:00:00 |
| NATIONAL FORMULARY NAME |
DIPHENHYDRAMINE/HYDROCORTISONE/NYSTATIN/TETRACYCLINE SUSP,ORAL |
| 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 |
DIPHENHYDRAM/HC/NYSTATIN/TCN MOUTHWASH |
| VA PRODUCT IDENTIFIER |
D0980 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4032494 |
| EFFECTIVE DATE/TIME |
-
- 2013-06-20 00:00:00
- STATUS: ACTIVE
|
