PEG-400 50%/PEG-4000 33% CREAM,OTIC (7375)    VA PRODUCT (50.68)

Name Value
NAME PEG-400 50%/PEG-4000 33% CREAM,OTIC
VA GENERIC NAME POLYETHYLENE GLYCOL 400/POLYETHYLENE GLYCOL 4000
DOSAGE FORM CREAM,OTIC
ACTIVE INGREDIENTS
CS FEDERAL SCHEDULE Unscheduled
INACTIVATION DATE 2007-10-01 00:00:00
DSS NUMBER 1
NATIONAL FORMULARY NAME POLYETHYLENE GLYCOL 400/POLYETHYLENE GLYCOL 4000 CREAM,OTIC
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 4007880
EFFECTIVE DATE/TIME
  • 2005-03-10 00:00:00
    STATUS:   ACTIVE
  • 2007-10-01 00:00:00
    STATUS:   INACTIVE