| NAME |
LIDOCAINE HCL 2% JELLY |
| VA GENERIC NAME |
LIDOCAINE |
| DOSAGE FORM |
JELLY |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
2 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| DSS NUMBER |
17 |
| NATIONAL FORMULARY NAME |
LIDOCAINE JELLY |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LIDOCAINE HCL 2% TOP JELLY |
| VA PRODUCT IDENTIFIER |
L0551 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4004389 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
