ALLANTOIN/AMINACRINE/SULFANILAMIDE W/DIENESTROL 0.01% CR,VAG (5106) VA PRODUCT (50.68)

Name	Value
NAME	ALLANTOIN/AMINACRINE/SULFANILAMIDE W/DIENESTROL 0.01% CR,VAG
VA GENERIC NAME	ALLANTOIN/AMINACRINE/DIENESTROL/SULFANILAMIDE
DOSAGE FORM	CREAM,VAG
ACTIVE INGREDIENTS	DIENESTROL STRENGTH: 0.01 UNITS: % ALLANTOIN STRENGTH: 2 UNITS: % AMINACRINE HYDROCHLORIDE STRENGTH: 0.2 UNITS: % SULFANILAMIDE STRENGTH: 15 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-18 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ALLANTOIN/AMINACRINE/DIENESTROL/SULFANILAMIDE 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	SULFANILAMIDE/DIENESTROL 0.01% VAG CREAM
VA PRODUCT IDENTIFIER	A0130
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4005647
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-18 00:00:00 STATUS: INACTIVE