| NAME |
ALLANTOIN 2%/LIDOCAINE 5%/PETROLATUM 30% PATCH |
| VA GENERIC NAME |
ALLANTOIN/LIDOCAINE/PETROLATUM |
| DOSAGE FORM |
PATCH |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| INACTIVATION DATE |
2016-02-25 00:00:00 |
| NATIONAL FORMULARY NAME |
ALLANTOIN/LIDOCAINE/PETROLATUM 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 |
ALLANTOIN 2%/LIDO 5%/PETROLATM 30% PATCH |
| VA PRODUCT IDENTIFIER |
A1784 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PATCH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034119 |
| EFFECTIVE DATE/TIME |
-
- 2015-01-30 00:00:00
- STATUS: ACTIVE
|
