| NAME |
GLYCERIN/PHENOL 0.3%/NA BICARB/NA BORATE MOUTHWASH |
| VA GENERIC NAME |
GLYCERIN/PHENOL/SODIUM BICARBONATE/SODIUM BORATE |
| DOSAGE FORM |
MOUTHWASH |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.3 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
% |
| DSS NUMBER |
1 |
| NATIONAL FORMULARY NAME |
GLYCERIN/PHENOL/SODIUM BICARBONATE/SODIUM BORATE MOUTHWASH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
GLY/PHNOL 0.3%/NA BICARB/NA BOR MOUTHWA |
| VA PRODUCT IDENTIFIER |
G0501 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
ML |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4009768 |
| EFFECTIVE DATE/TIME |
-
- 2005-03-10 00:00:00
- STATUS: ACTIVE
|
