MENTHOL 0.5%/PRAMOXINE 1% LOTION (8969) VA PRODUCT (50.68)

Name	Value
NAME	MENTHOL 0.5%/PRAMOXINE 1% LOTION
VA GENERIC NAME	MENTHOL/PRAMOXINE
DOSAGE FORM	LOTION
ACTIVE INGREDIENTS	MENTHOL STRENGTH: 0.5 UNITS: % PRAMOXINE HYDROCHLORIDE STRENGTH: 1 UNITS: %
CS FEDERAL SCHEDULE	Unscheduled
DSS NUMBER	1
NATIONAL FORMULARY NAME	MENTHOL/PRAMOXINE LOTION
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	MENTHOL 0.5/PRAMOXINE 1% LOTION
VA PRODUCT IDENTIFIER	M0172
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009414
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE