GABAPENTIN 300MG/LIDOCAINE 4%/MENTHOL 1% KIT (26780) VA PRODUCT (50.68)

Name	Value
NAME	GABAPENTIN 300MG/LIDOCAINE 4%/MENTHOL 1% KIT
VA GENERIC NAME	GABAPENTIN/LIDOCAINE/MENTHOL
DOSAGE FORM	KIT
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 1 UNITS: % GABAPENTIN STRENGTH: 300 UNITS: MG LIDOCAINE STRENGTH: 4 UNITS: %
NATIONAL FORMULARY NAME	GABAPENTIN/LIDOCAINE/MENTHOL KIT
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	GABAPENTIN 300MG/LIDO 4%/MENTHOL 1% KIT
VA PRODUCT IDENTIFIER	G0431
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	KIT
MASTER ENTRY FOR VUID	YES
VUID	4035623
EFFECTIVE DATE/TIME	2016-04-19 00:00:00 STATUS: ACTIVE