LIDOCAINE 3.5%/MENTHOL 7% PATCH (30436)    VA PRODUCT (50.68)

Name Value
NAME LIDOCAINE 3.5%/MENTHOL 7% PATCH
VA GENERIC NAME LIDOCAINE/MENTHOL
DOSAGE FORM PATCH
HAZARDOUS TO DISPOSE NO
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
SINGLE/MULTI SOURCE PRODUCT Multisource
NATIONAL FORMULARY NAME LIDOCAINE/MENTHOL PATCH
CREATE DEFAULT POSSIBLE DOSAGE YES
CODING SYSTEM
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   2
    COPAY EFFECTIVE DATE:   2020-10-01 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME LIDOCAINE 3.5%/MENTHOL 7% PATCH
VA PRODUCT IDENTIFIER L0854
TRANSMIT TO CMOP YES
VA DISPENSE UNIT PATCH
MASTER ENTRY FOR VUID YES
VUID 4039732
EFFECTIVE DATE/TIME
  • 2020-10-02 00:00:00
    STATUS:   ACTIVE
  • 2020-10-02 00:00:00
    STATUS:   ACTIVE
  • 2020-10-02 00:00:00
    STATUS:   ACTIVE