| NAME |
LIDOCAINE HCL 2% JELLY,GLYDO,11ML |
| VA GENERIC NAME |
LIDOCAINE |
| DOSAGE FORM |
JELLY |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
2 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
LIDOCAINE JELLY |
| 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 |
LIDOCAINE HCL 2% JELLY GLYDO 11ML |
| VA PRODUCT IDENTIFIER |
L0673 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034887 |
| EFFECTIVE DATE/TIME |
-
- 2015-10-15 00:00:00
- STATUS: ACTIVE
|
