| NAME |
SULFACETAMIDE NA 10%/SULFUR 2% FOAM,TOP |
| VA GENERIC NAME |
SULFACETAMIDE/SULFUR |
| DOSAGE FORM |
FOAM,TOP |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
SULFACETAMIDE/SULFUR FOAM,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2022-11-06 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-11-07 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SULFACETAMIDE NA 10%/SULFUR 2% TOP FOAM |
| VA PRODUCT IDENTIFIER |
S0773 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034586 |
| EFFECTIVE DATE/TIME |
-
- 2015-07-10 00:00:00
- STATUS: ACTIVE
|
