TRIPLE DYE PIN POINT APPLICATOR,TOP (6379) VA PRODUCT (50.68)

Name	Value
NAME	TRIPLE DYE PIN POINT APPLICATOR,TOP
VA GENERIC NAME	BRILLIANT GREEN/GENTIAN VIOLET/PROFLAVINE
DOSAGE FORM	SOLN,TOP
ACTIVE INGREDIENTS	BRILLIANT GREEN STRENGTH: 2.29 UNITS: MG GENTIAN VIOLET STRENGTH: 2.29 UNITS: MG PROFLAVINE HEMISULFATE STRENGTH: 1.14 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	2
NATIONAL FORMULARY NAME	BRILLIANT GREEN/GENTIAN VIOLET/PROFLAVINE SOLN,TOP
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 3 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00 COPAY END DATE: 2020-05-06 00:00:00 COPAY TIER LEVEL: 2 COPAY EFFECTIVE DATE: 2020-05-07 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	TRIPLE DYE PIN POINT TOP APPLICATOR
VA PRODUCT IDENTIFIER	T1067
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4006899
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE