| NAME |
GLYCERIN 4.5% MOUTHWASH |
| VA GENERIC NAME |
GLYCERIN |
| DOSAGE FORM |
MOUTHWASH |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
4.5 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
GLYCERIN MOUTHWASH |
| 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 |
GLYCERIN 4.5% MOUTHWASH |
| VA PRODUCT IDENTIFIER |
G0428 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035572 |
| EFFECTIVE DATE/TIME |
-
- 2016-03-30 00:00:00
- STATUS: ACTIVE
|
