COAL TAR SOLN 10%/NA LAURYL SO4 15% SHAMPOO (8269) VA PRODUCT (50.68)

Name	Value
NAME	COAL TAR SOLN 10%/NA LAURYL SO4 15% SHAMPOO
VA GENERIC NAME	COAL TAR/LAURAMIDE DEA/SODIUM LAURYL SULFATE
DOSAGE FORM	SHAMPOO
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	ALCOHOL STRENGTH: 8.3 UNITS: % COAL TAR SOLUTION STRENGTH: 10 UNITS: % LAURAMIDE DEA SODIUM LAURYL SULFATE STRENGTH: 15 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-19 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	COAL TAR/LAURAMIDE DEA/SODIUM LAURYL SULFATE SHAMPOO
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
VA PRINT NAME	COAL TAR 10/NA LAURYL SULF 15% SHAMPOO
VA PRODUCT IDENTIFIER	C0501
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4008739
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-19 00:00:00 STATUS: INACTIVE