DIOXYBENZONE 3%/PABA 5%/HYDROQUINONE 4% GEL,TOP (6488) VA PRODUCT (50.68)

Name	Value
NAME	DIOXYBENZONE 3%/PABA 5%/HYDROQUINONE 4% GEL,TOP
VA GENERIC NAME	DIOXYBENZONE/ETHYL DIHYDROXYPROPYL PABA/HYDROQUINONE
DOSAGE FORM	GEL,TOP
ACTIVE INGREDIENTS	HYDROQUINONE STRENGTH: 4 UNITS: % DIOXYBENZONE STRENGTH: 3 UNITS: % ETHYL DIHYDROXYPROPYL PABA STRENGTH: 5 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	2
NATIONAL FORMULARY NAME	DIOXYBENZONE/ETHYL DIHYDROXYPROPYL PABA/HYDROQUINONE GEL,TOP
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4007007
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE