AQUADERM LOTION (9777) VA PRODUCT (50.68)

Name	Value
NAME	AQUADERM LOTION
VA GENERIC NAME	AQUADERM
DOSAGE FORM	LOTION,TOP
ACTIVE INGREDIENTS	MINERAL OIL PETROLATUM WATER MENTHOL CETYL ALCOHOL CARBOMER 934 DIMETHICONE 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
CS FEDERAL SCHEDULE	Unscheduled
INACTIVATION DATE	2007-09-18 00:00:00
DSS NUMBER	2
NATIONAL FORMULARY NAME	AQUADERM LOTION,TOP
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 LOTION
VA PRODUCT IDENTIFIER	A0891
TRANSMIT TO CMOP	NO
VA DISPENSE UNIT	ML
MASTER ENTRY FOR VUID	YES
VUID	4010185
EFFECTIVE DATE/TIME	2005-03-10 00:00:00 STATUS: ACTIVE 2007-09-18 00:00:00 STATUS: INACTIVE