SODIUM FLUORIDE 2.72% FOAM,DENT (25839)    VA PRODUCT (50.68)

Name Value
NAME SODIUM FLUORIDE 2.72% FOAM,DENT
VA GENERIC NAME SODIUM FLUORIDE
DOSAGE FORM FOAM,DENT
FORMULARY DESIGNATOR TEXT 
Not provided by pharmacy for inpatient use.
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 2.72
SINGLE/MULTI SOURCE PRODUCT Multisource
UNITS %
NATIONAL FORMULARY NAME SODIUM FLUORIDE FOAM,DENT
CREATE DEFAULT POSSIBLE DOSAGE NO
POSSIBLE DOSAGES TO CREATE No Possible Dosages
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 SODIUM FLUORIDE 2.72% DENT FOAM
VA PRODUCT IDENTIFIER S0775
TRANSMIT TO CMOP NO
VA DISPENSE UNIT GM
MASTER ENTRY FOR VUID YES
VUID 4034597
EFFECTIVE DATE/TIME
  • 2015-07-10 00:00:00
    STATUS:   ACTIVE