DAPSONE 7.5% GEL,TOP (26784)    VA PRODUCT (50.68)

Name Value
NAME DAPSONE 7.5% GEL,TOP
VA GENERIC NAME DAPSONE
DOSAGE FORM GEL,TOP
ACTIVE INGREDIENTS
  • DAPSONE
    STRENGTH:   7.5
    UNITS:   %
CS FEDERAL SCHEDULE Unscheduled
STRENGTH 7.5
SINGLE/MULTI SOURCE PRODUCT Single source
UNITS %
NATIONAL FORMULARY NAME DAPSONE GEL,TOP
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2017-02-27 00:00:00
    COPAY END DATE:   2019-12-26 00:00:00
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2019-12-27 00:00:00
PGX ELIGIBLE YES
PGX SUPPRESSED NO
VA PRINT NAME DAPSONE 7.5% TOP GEL
VA PRODUCT IDENTIFIER D1122
TRANSMIT TO CMOP YES
VA DISPENSE UNIT GM
MASTER ENTRY FOR VUID YES
VUID 4035631
EFFECTIVE DATE/TIME
  • 2016-04-22 00:00:00
    STATUS:   ACTIVE