ACI-JEL JELLY,VAG (4732) VA PRODUCT (50.68)

Name	Value
NAME	ACI-JEL JELLY,VAG
VA GENERIC NAME	ACETIC ACID/GLYCERIN/OXYQUINOLINE/RICINOLEIC ACID
DOSAGE FORM	JELLY,VAG
ACTIVE INGREDIENTS	OXYQUINOLINE STRENGTH: 0.025 UNITS: % RICINOLEIC ACID STRENGTH: 0.7 UNITS: % GLYCERIN STRENGTH: 5 UNITS: % ACETIC ACID STRENGTH: 0.921 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2008-09-03 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ACETIC ACID/GLYCERIN/OXYQUINOLINE/RICINOLEIC ACID JELLY,VAG
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	ACI-JEL VAG JELLY
VA PRODUCT IDENTIFIER	A0496
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4005279
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2008-09-03 00:00:00 STATUS: INACTIVE