| NAME |
LIDOCAINE 4%/MENTHOL 2%/METHYL SALICYLATE 16% PATCH |
| VA GENERIC NAME |
LIDOCAINE/MENTHOL/METHYL SALICYLATE |
| DOSAGE FORM |
PATCH |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| INACTIVATION DATE |
2016-06-15 00:00:00 |
| NATIONAL FORMULARY NAME |
LIDOCAINE/MENTHOL/METHYL SALICYLATE PATCH |
| 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 |
LIDO 4%/MENTHOL 2%/METHYL SAL 16% PATCH |
| VA PRODUCT IDENTIFIER |
L0643 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034004 |
| EFFECTIVE DATE/TIME |
-
- 2014-12-29 00:00:00
- STATUS: ACTIVE
|
