GORDOMATIC PWDR,TOP (9635) VA PRODUCT (50.68)

Name	Value
NAME	GORDOMATIC PWDR,TOP
VA GENERIC NAME	ALUM/CAMPHOR/EUCALYPTUS/MENTHOL/SALICYLIC/TALC/THYMOL
DOSAGE FORM	POWDER
ACTIVE INGREDIENTS	CAMPHOR SALICYLIC ACID MENTHOL EUCALYPTUS OIL THYMOL TALC ALUM BENTONITE
CS FEDERAL SCHEDULE	Unscheduled
SINGLE/MULTI SOURCE PRODUCT	Multisource
DSS NUMBER	1
NATIONAL FORMULARY NAME	ALUM/CAMPHOR/EUCALYPTUS/MENTHOL/SALICYLIC/TALC/THYMOL POWDER
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	4010048
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE