COAL TAR 5%/SALICYLIC ACID 2%/SULFUR 2% SHAMPOO (9280) VA PRODUCT (50.68)

Name	Value
NAME	COAL TAR 5%/SALICYLIC ACID 2%/SULFUR 2% SHAMPOO
VA GENERIC NAME	COAL TAR/SALICYLIC ACID/SULFUR
DOSAGE FORM	SHAMPOO
ACTIVE INGREDIENTS	SULFUR,COLLOIDAL STRENGTH: 2 UNITS: % SALICYLIC ACID STRENGTH: 2 UNITS: % WATER COAL TAR SOLUTION STRENGTH: 5 UNITS: % FRAGRANCE SOY LECITHIN XANTHAN GUM ALCOHOL SULFATE COMPOUND
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2012-06-06 00:00:00
DSS NUMBER	3
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 5/SAL AC 2/SULFUR 2% SHAMPOO
VA PRODUCT IDENTIFIER	C1112
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4009706
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2012-06-06 00:00:00 STATUS: INACTIVE