| NAME |
LIDOCAINE 3.88% CREAM,TOP |
| VA GENERIC NAME |
LIDOCAINE |
| DOSAGE FORM |
CREAM,TOP |
| FORMULARY DESIGNATOR TEXT |
Sites can interchange different strengths of lidocaine cream or ointment
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
3.88 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
LIDOCAINE CREAM,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2017-11-30 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-12-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LIDOCAINE 3.88% TOP CREAM |
| VA PRODUCT IDENTIFIER |
L0705 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035968 |
| EFFECTIVE DATE/TIME |
-
- 2016-08-11 00:00:00
- STATUS: ACTIVE
|
