GORDOMATIC CRYSTALS (9633) VA PRODUCT (50.68)

Name	Value
NAME	GORDOMATIC CRYSTALS
VA GENERIC NAME	MENTHOL/SODIUM BICARBONATE/SODIUM BORATE/SODIUM CHLORIDE/THYMOL
DOSAGE FORM	CRYSTAL
ACTIVE INGREDIENTS	MENTHOL EUCALYPTUS OIL THYMOL SODIUM BORATE SODIUM CHLORIDE SODIUM BICARBONATE
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Single source
DSS NUMBER	1
NATIONAL FORMULARY NAME	MENTHOL/SODIUM BICARBONATE/SODIUM BORATE/SODIUM CHLORIDE/THYMOL CRYSTAL
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
TRANSMIT TO CMOP	NO
MASTER ENTRY FOR VUID	YES
VUID	4010046
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE