TRIPLE SULFA CREAM,VAG (4748) VA PRODUCT (50.68)

Name	Value
NAME	TRIPLE SULFA CREAM,VAG
VA GENERIC NAME	SULFABENZAMIDE/SULFACETAMIDE/SULFATHIAZOLE/UREA
DOSAGE FORM	CREAM,VAG
ACTIVE INGREDIENTS	UREA STRENGTH: 0.64 UNITS: % SULFABENZAMIDE STRENGTH: 3.7 UNITS: % SULFACETAMIDE STRENGTH: 2.86 UNITS: % SULFATHIAZOLE STRENGTH: 3.42 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2010-10-06 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	SULFABENZAMIDE/SULFACETAMIDE/SULFATHIAZOLE/UREA CREAM,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	TRIPLE SULFA VAG CREAM
VA PRODUCT IDENTIFIER	T0217
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4005294
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2010-10-06 00:00:00 STATUS: INACTIVE