BENZOYL PEROXIDE 3.75%/CLINDAMYCIN PO4 1.2% GEL,TOP (25270)    VA PRODUCT (50.68)

Name Value
NAME BENZOYL PEROXIDE 3.75%/CLINDAMYCIN PO4 1.2% GEL,TOP
VA GENERIC NAME BENZOYL PEROXIDE/CLINDAMYCIN
DOSAGE FORM GEL,TOP
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME BENZOYL PEROXIDE/CLINDAMYCIN GEL,TOP
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 BENZOYL PEROX 3.75/CLINDAMY 1.2% TOP GEL
VA PRODUCT IDENTIFIER B0754
TRANSMIT TO CMOP NO
VA DISPENSE UNIT GM
MASTER ENTRY FOR VUID YES
VUID 4033965
EFFECTIVE DATE/TIME
  • 2014-12-19 00:00:00
    STATUS:   ACTIVE