| NAME |
GLYCERIN 14.4/LIDOCAINE 5/PETROLATUM 15/PHENYLEPHR 0.25% CRM,RTL |
| VA GENERIC NAME |
GLYCERIN/LIDOCAINE/PETROLATUM/PHENYLEPHRINE |
| DOSAGE FORM |
CREAM,RTL |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
GLYCERIN/LIDOCAINE/PETROLATUM/PHENYLEPHRINE CREAM,RTL |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-06-01 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
PREPARATION H RAPID RELIEF W/LIDO CREAM |
| VA PRODUCT IDENTIFIER |
P1275 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
GM |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4039413 |
| EFFECTIVE DATE/TIME |
-
- 2020-06-02 00:00:00
- STATUS: ACTIVE
|
