GLYCERIN 1%/TETRAHYDROZOLINE 0.05%/BORIC AC/NA BORATE OPH,IRR (8657) VA PRODUCT (50.68)

Name	Value
NAME	GLYCERIN 1%/TETRAHYDROZOLINE 0.05%/BORIC AC/NA BORATE OPH,IRR
VA GENERIC NAME	BORIC ACID/GLYCERIN/SODIUM BORATE/TETRAHYDROZOLINE
DOSAGE FORM	SOLN,OPH
ACTIVE INGREDIENTS	TETRAHYDROZOLINE HYDROCHLORIDE STRENGTH: 0.05 UNITS: % SODIUM BORATE GLYCERIN STRENGTH: 1 UNITS: % EDETATE DISODIUM STRENGTH: 0.1 UNITS: % BORIC ACID BENZALKONIUM CHLORIDE STRENGTH: 0.01 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-20 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	BORIC ACID/GLYCERIN/SODIUM BORATE/TETRAHYDROZOLINE SOLN,OPH
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	COLLYRIUM FRESH EYE DROPS
VA PRODUCT IDENTIFIER	G0059
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009115
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-20 00:00:00 STATUS: INACTIVE