| NAME |
DOMEBORO PWDR PKTS,TOP |
| VA GENERIC NAME |
ALUMINUM SULFATE/CALCIUM ACETATE |
| DOSAGE FORM |
POWDER,TOP |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| INACTIVATION DATE |
2000-03-16 00:00:00 |
| DSS NUMBER |
2 |
| NATIONAL FORMULARY NAME |
ALUMINUM SULFATE/CALCIUM ACETATE POWDER,TOP |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
ALUMINUM ACETATE TOP PWD |
| VA PRODUCT IDENTIFIER |
A0563 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4008544 |
| EFFECTIVE DATE/TIME |
-
- 2000-03-16 00:00:00
- STATUS: INACTIVE
-
- 2005-12-08 00:00:00
- STATUS: INACTIVE
|
