BISMUTH SUBGALLATE/BORIC ACID/ZINC OXIDE SUPP,RTL (9565) VA PRODUCT (50.68)

Name	Value
NAME	BISMUTH SUBGALLATE/BORIC ACID/ZINC OXIDE SUPP,RTL
VA GENERIC NAME	BISMUTH SUBGALLATE/BORIC ACID/ZINC OXIDE
DOSAGE FORM	SUPP,RTL
ACTIVE INGREDIENTS	BISMUTH SUBGALLATE PERUVIAN BALSAM BISMUTH RESORCIN COMPOUND ZINC OXIDE BORIC ACID
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-18 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	BISMUTH SUBGALLATE/BORIC ACID/ZINC OXIDE SUPP,RTL
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	HEMORRHOIDAL RTL SUPP
VA PRODUCT IDENTIFIER	H0027
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	EA
MASTER ENTRY FOR VUID	YES
VUID	4009981
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-18 00:00:00 STATUS: INACTIVE