LIDOCAINE 4%/MENTHOL 5%/METHYL SALICYLATE 4% PATCH (25308) VA PRODUCT (50.68)

Name	Value
NAME	LIDOCAINE 4%/MENTHOL 5%/METHYL SALICYLATE 4% PATCH
VA GENERIC NAME	LIDOCAINE/MENTHOL/METHYL SALICYLATE
DOSAGE FORM	PATCH
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 5 UNITS: % METHYL SALICYLATE STRENGTH: 4 UNITS: % LIDOCAINE STRENGTH: 4 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	LIDOCAINE/MENTHOL/METHYL SALICYLATE PATCH
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	LIDO 4%/MENTHOL 5%/METHYL SAL 4% PATCH
VA PRODUCT IDENTIFIER	L0642
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	PATCH
MASTER ENTRY FOR VUID	YES
VUID	4034006
EFFECTIVE DATE/TIME	2014-12-29 00:00:00 STATUS: ACTIVE