| NAME |
SODIUM FLUORIDE 1.23% GEL |
| VA GENERIC NAME |
SODIUM FLUORIDE |
| DOSAGE FORM |
GEL,DENT |
| FORMULARY DESIGNATOR TEXT |
Restricted to Dental for use in patients with head / neck cancer or with custom made trays according to risk category algorithm in information letter. Not provided by pharmacy for inpatient use.
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
1.23 |
| INACTIVATION DATE |
2007-09-25 00:00:00 |
| UNITS |
% |
| DSS NUMBER |
6 |
| NATIONAL FORMULARY NAME |
SODIUM FLUORIDE GEL,DENT |
| 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 |
| TRANSMIT TO CMOP |
NO |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4004922 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
-
- 2007-09-25 00:00:00
- STATUS: INACTIVE
|
