LUBRASEPTIC JELLY,TOP (9627) VA PRODUCT (50.68)

Name	Value
NAME	LUBRASEPTIC JELLY,TOP
VA GENERIC NAME	AMYL PHENYL PHENOL COMPLEX/PHENYLMERCURIC NITRATE
DOSAGE FORM	JELLY,TOP
HAZARDOUS TO DISPOSE	NO
ACTIVE INGREDIENTS	AMYL PHENYL PHENOL COMPLEX STRENGTH: 1.2 UNITS: MG/GM PHENYLMERCURIC NITRATE STRENGTH: 0.07 UNITS: MG/GM
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-20 00:00:00
DSS NUMBER	1
NATIONAL FORMULARY NAME	AMYL PHENYL PHENOL COMPLEX/PHENYLMERCURIC NITRATE JELLY,TOP
CREATE DEFAULT POSSIBLE DOSAGE	YES
CODING SYSTEM	RxNorm CODE:
COPAY TIER	COPAY TIER LEVEL: 0 COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
PGX ELIGIBLE	NO
PGX SUPPRESSED	NO
VA PRINT NAME	ANTISEPTIC/LUBRICATING TOP JELLY
VA PRODUCT IDENTIFIER	L0072
TRANSMIT TO CMOP	YES
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	YES
VUID	4010040
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-20 00:00:00 STATUS: INACTIVE