HEMORRHOIDAL W/BENZOCAINE SUPP,RTL (8307) VA PRODUCT (50.68)

Name	Value
NAME	HEMORRHOIDAL W/BENZOCAINE SUPP,RTL
VA GENERIC NAME	BENZOCAINE/BISMUTH SUBGALLATE/PHENYLMECURIC NITRATE/ZINC OXIDE
DOSAGE FORM	SUPP,RTL
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	CAMPHOR STRENGTH: 42 UNITS: MG BISMUTH SUBGALLATE ZINC OXIDE STRENGTH: 77.2 UNITS: MG SHARK LIVER OIL EPHEDRINE SULFATE STRENGTH: 3.8 UNITS: MG PHENYLMERCURIC NITRATE STRENGTH: 0.01 UNITS: % BENZOCAINE STRENGTH: 15.4 UNITS: MG
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2004-11-18 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	BENZOCAINE/BISMUTH SUBGALLATE/PHENYLMECURIC NITRATE/ZINC OXIDE SUPP,RTL
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	HEMORRHOIDAL W/BENZOCAINE RTL SUPP
VA PRODUCT IDENTIFIER	H0198
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	NO
VUID	4008775
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2007-09-28 00:00:00 STATUS: INACTIVE 2004-11-18 00:00:00 STATUS: INACTIVE