ALLANTOIN 140MG/AMINACRINE 14MG/SULFANILAMIDE 1.05GM SUPP,VAG (5108) VA PRODUCT (50.68)

Name	Value
NAME	ALLANTOIN 140MG/AMINACRINE 14MG/SULFANILAMIDE 1.05GM SUPP,VAG
VA GENERIC NAME	ALLANTOIN/AMINACRINE/SULFANILAMIDE
DOSAGE FORM	SUPP,VAG
ACTIVE INGREDIENTS	ALLANTOIN STRENGTH: 140 UNITS: MG AMINACRINE HYDROCHLORIDE STRENGTH: 14 UNITS: MG SULFANILAMIDE STRENGTH: 1.05 UNITS: GM
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-18 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	ALLANTOIN/AMINACRINE/SULFANILAMIDE SUPP,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 1.05GM VAG SUPP
VA PRODUCT IDENTIFIER	A0126
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4005649
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-18 00:00:00 STATUS: INACTIVE