COAL TAR 0.5%/SALICYLIC ACID 2%/SULFUR 2% SHAMPOO (9278) VA PRODUCT (50.68)

Name	Value
NAME	COAL TAR 0.5%/SALICYLIC ACID 2%/SULFUR 2% SHAMPOO
VA GENERIC NAME	COAL TAR/SALICYLIC ACID/SULFUR
DOSAGE FORM	SHAMPOO
ACTIVE INGREDIENTS	COAL TAR STRENGTH: 0.5 UNITS: % LANOLIN OIL SALICYLIC ACID STRENGTH: 2 UNITS: % SULFUR STRENGTH: 2 UNITS: % TITANIUM DIOXIDE DOCUSATE SODIUM D & C YELLOW #10 F D & C BLUE #1 FRAGRANCE OCTOXYNOL 2 ETHANESULFONATE SODIUM PEG-6 LAURAMIDE PEG-90M SODIUM DODECYL BENZENE SULFONATE EDTA
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2009-07-24 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	COAL TAR/SALICYLIC ACID/SULFUR 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 0.5/SAL AC 2/SULFUR 2% SHAMPOO
VA PRODUCT IDENTIFIER	C0306
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009704
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2009-07-24 00:00:00 STATUS: INACTIVE