TRIVA JELLY,VAG (7427) VA PRODUCT (50.68)

Name	Value
NAME	TRIVA JELLY,VAG
VA GENERIC NAME	ALKYL/AMINACRINE/BENZOXIQUINE/CUPRIC/EDETATE/SODIUM
DOSAGE FORM	JELLY,VAG
ACTIVE INGREDIENTS	AMINACRINE HYDROCHLORIDE STRENGTH: 10 UNITS: MG ALKYL ARYL SODIUM SULFONATE STRENGTH: 62.5 UNITS: MG BENZOXIQUINE STRENGTH: 7.5 UNITS: MG SODIUM SULFATE STRENGTH: 6.9 UNITS: MG CUPRIC SULFATE,ANHYDROUS STRENGTH: 0.063 UNITS: MG EDETATE DISODIUM STRENGTH: 2.5 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2002-12-06 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	ALKYL/AMINACRINE/BENZOXIQUINE/CUPRIC/EDETATE/SODIUM JELLY,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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4007932
EFFECTIVE DATE/TIME	2002-12-06 00:00:00 STATUS: INACTIVE 2005-12-08 00:00:00 STATUS: INACTIVE