| NAME |
DIMETHICONE/DIMETHICONE CROSSPOLYMER/TRIMETHYLSILOXYSILICATE GEL |
| VA GENERIC NAME |
DIMETHICONE/TRIMETHYLSILOXYSILICATE |
| DOSAGE FORM |
GEL,TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
DIMETHICONE/TRIMETHYLSILOXYSILICATE GEL,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2018-08-02 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
KELARX TOP GEL |
| VA PRODUCT IDENTIFIER |
K0072 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037724 |
| EFFECTIVE DATE/TIME |
-
- 2018-08-02 00:00:00
- STATUS: ACTIVE
|
