AQUADERM CREAM (9776) VA PRODUCT (50.68)

Name	Value
NAME	AQUADERM CREAM
VA GENERIC NAME	AQUADERM
DOSAGE FORM	CREAM
ACTIVE INGREDIENTS	MINERAL OIL SALICYLIC ACID STRENGTH: 0.1 UNITS: % MENTHOL EDETATE SODIUM CETYL ALCOHOL CARBOMER 934 DIMETHICONE GLYCERIN STRENGTH: 25 UNITS: % LECITHIN MAGNESIUM ALUMINUM SILICATE BUTYLATED HYDROXYTOLUENE DIAZOLIDINYL UREA GLYCERYL STEARATE HYALURONATE SODIUM SQUALANE STEARIC ACID XANTHAN GUM CAPRYLIC TRIGLYCERIDE DICHLOROBENZYL ALCOHOL METHYL GLUCETH-10 PEG-50 STEARATE SODIUM POLYGLUTAMATE SODIUM HYDROXIDE
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2012-01-04 00:00:00
DSS NUMBER	3
NATIONAL FORMULARY NAME	AQUADERM CREAM
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	AQUADERM CREAM
VA PRODUCT IDENTIFIER	A0890
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	GM
MASTER ENTRY FOR VUID	NO
VUID	4010184
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2005-12-08 00:00:00 STATUS: ACTIVE 2012-01-04 00:00:00 STATUS: INACTIVE 2004-11-18 00:00:00 STATUS: INACTIVE