HYDROCORTISONE 25MG/PRAMOXINE 18MG SUPP,RTL (31990) VA PRODUCT (50.68)

Name	Value
NAME	HYDROCORTISONE 25MG/PRAMOXINE 18MG SUPP,RTL
VA GENERIC NAME	HYDROCORTISONE/PRAMOXINE
DOSAGE FORM	SUPP,RTL
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	HYDROCORTISONE ACETATE STRENGTH: 25 UNITS: MG PRAMOXINE HYDROCHLORIDE STRENGTH: 18 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
NATIONAL FORMULARY NAME	HYDROCORTISONE/PRAMOXINE SUPP,RTL
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2022-05-26 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	HYDROCORTISO 25MG/PRAMOXNE 18MG RTL SUPP
VA PRODUCT IDENTIFIER	H0769
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4041437
EFFECTIVE DATE/TIME	2022-05-26 00:00:00 STATUS: ACTIVE